A 31-year-old man was admitted to our hospital, complaining of
muscular weakness and
pain in the legs one month after a
common cold. On admission, neurological examinations demonstrated moderate weakness in the arms and mild weakness in the legs with decreased or diminished deep tendon reflexes, and mild
dysphagia. Weakness was gradually extended to the arm, throat and respiratory muscles, requiring artificial ventilation. Laboratory examinations demonstrated increased levels of CK (upto 24,380 IU/L) and positive anti-cytomegalovirus (CMV) -
IgM antibodies in the serum, and myogloburinuria. CMV was not detected in either the blood cells or muscles by PCR. There were no
antibodies against viruses including Ebstein-Barr virus and HIV, in the serum. There were no
autoantibodies related to
collagen diseases in the serum. Systemic PET scan did not show any evidence of
malignancy. Bone marrow biopsy did not show any atypical cells. Muscle MRI demonstrated mild
atrophy with high intensity signals in part. Muscle biopsy demonstrated scattered necrotic and regenerated muscle fibers without inflammatory cell infiltration. The patient was therefore diagnosed as having
rhabdomyolysis associated with CMV
infection. After three courses of intravenously administered high dose methylprednislone over three days,
muscle weakness improved gradually, and the serum CK level was normalized in two months. The patient recovered and was removed from artificial ventilation three months after the
therapy. There were no sign of
renal failure.
Steroid therapy should be considered for the treatment of
rhabdomyolysis or
myopathy associated with CMV
infection in order to prevent
renal failure or fatal progression of the disease.