Guillain-Barré syndrome following heart transplantation complicated by myocardial infarction following treatment with IVIg

Abstract

Guillain-Barré syndrome (GBS) is rare autoimmune polyneuropathy that is infrequently seen in the post-transplant population, presumably due to the presence of immunosuppression. When it does occur in this setting, Cytomegalovirus (CMV) infection is a common inciting factor. Treatment modalities for GBS include intravenous immunoglobulin (IVIg) or plasmapheresis. Rarely, IVIg infusion has been associated with myocardial infarction. We describe a case of a patient status post heart transplantation who presented with GBS shortly after developing CMV viremia. When treatment with IVIg was initiated, our patient developed myocardial infarction with acute cardiac biomarker elevation, acute systolic dysfunction, and cardiogenic shock requiring inotropic and vasopressor support. Coronary angiography demonstrated no significant coronary artery disease. The patient’s cardiac function recovered, as did the GBS following initiation of plasmapheresis. We review prior cases of GBS in transplant patients as well as IVIg associated myocardial infarction.