title: Guillain-Barré syndrome associated with resistant cytomegalovirus infection after face transplantation.
abstract: A 39-year-old male, who received a facial allograft (cytomegalovirus [CMV] donor-seropositive, recipient-seronegative), developed multidrug-resistant CMV infection despite valganciclovir prophylaxis (900 mg/day) 6 months post transplantation. Lower extremity weakness with upper and lower extremity paresthesias developed progressively 11 months post transplantation, coinciding with immune control of CMV. An axonal form of Guillain-Barré syndrome was diagnosed, based on electrophysiological evidence of a generalized, non-length-dependent, sensorimotor axonal polyneuropathy. Treatment with intravenous immunoglobulin led to complete recovery without recurrence after 6 months.
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: M
authors.initials: M
authors.lastname: Alhefzi
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Aycart
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: E M
authors.initials: EM
authors.lastname: Bueno
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: M
authors.initials: M
authors.lastname: Kueckelhaus
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: S
authors.initials: S
authors.lastname: Fischer
authors.affiliation: Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: R J
authors.initials: RJ
authors.lastname: Snook
authors.affiliation: Division of Nephrology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: A A
authors.initials: AA
authors.lastname: Sharfuddin
authors.affiliation: Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: I
authors.initials: I
authors.lastname: Hadad
authors.affiliation: Division of Neuromuscular Disease, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: P
authors.initials: P
authors.lastname: Malla
authors.affiliation: Division of Neuromuscular Disease, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: A A
authors.initials: AA
authors.lastname: Amato
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: B
authors.initials: B
authors.lastname: Pomahac
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: F M
authors.initials: FM
authors.lastname: Marty
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D003587:Cytomegalovirus / Q000187:drug effects / Q000302:isolation & purification; D003586:Cytomegalovirus Infections / Q000150:complications*; D024921:Drug Resistance, Multiple, Viral; D054445:Facial Transplantation / Q000009:adverse effects*; D015774:Ganciclovir / Q000031:analogs & derivatives / Q000627:therapeutic use; D020275:Guillain-Barre Syndrome / Q000209:etiology*; D006801:Humans; D016867:Immunocompromised Host; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D008297:Male; D013997:Time Factors; D000077562:Valganciclovir; D019562:Viral Load; D014766:Viremia
chemical_list: D000998:Antiviral Agents; D016756:Immunoglobulins, Intravenous; D000077562:Valganciclovir; D015774:Ganciclovir
keywords: Guillain-Barré syndrome; cytomegalovirus; face transplantation; peripheral neuropathy; vascularized composite allotransplantation