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Rehabilitation Practice and Science

Translated Title

巨細胞病毒感染併發嚴重橫紋肌溶解症和吞嚥障礙：個案報告及文獻回顧

Abstract

Cytomegalovirus(CMV) is a common virus that usually occurs in immunocompromised patients. After primary infection with CMV, the virus becomes latent in multiple organs and can later be reactivated during severe immune system dysregulation. Rhabdomyolysis is a disease of human muscle cell necrosis, and the rapid dissolution of damaged or injured muscles may lead to acute kidney injury or multiple organ failure. After reviewarticleing relevant literature, patients with severe rhabdomyolysis caused by CMV infection are rarely reported and even less commonly, CMV leads to severe dysphagia. The patient was a 35-year-old woman without underlying disease. Two months before hospitalization,she visited the emergency department due to four limbs muscle weakness, headache, dysphagia and intermittent fever. Four days later, symptoms persisted, and lab data showed increased C-reactive protein, abnormal liver function, and complete blood cell and differential count that was lymphocyte-dominant. Infectious mononucleosis was diagnosed. One week later, symptoms persisted, and lab data showed immunoglobulin (Ig)M-positive. Cytomegaloviral hepatitis was diagnosed. She was admitted to our hospital because of persistent general malaise, soreness, tachycardia, tea-colored urine, abnormal liver function and swallowing difficulties 1 month later. During hospitalization, rhabdomyolysis was diagnosed concomitant with the CMV infection. With the rhabdomyolysis-associated deterioration, the patient developed quadriplegia and severe dysphagia, and she required a nasogastric tube for nutrient intake. A video fluoroscopic swallowing study (VFSS) with barium as a thickening liquid was used to assess her swallowing function. In the lateral view of VFSS, she swallowed 2 mL of barium. The oral phase showed insufficient chewing, insufficient mixing bolus and insufficient bolus formation. Severe swallowing dysfunction of pharyngeal phase was noted, including poor pharyngeal constriction, poor epiglottis closure, poor laryngeal elevation, much residuein the vallecula and pyriform sinus, and the presence of penetration during swallowing. In the anterior–posterior view, the pharyngeal muscle group showed general weakness and much residue in bilateral pyriform sinus after swallowing. Two weeks after discharge, the patient attempted oral intake with a single consistency, and the nasogastric tube was removed 1 month later. Cytomegalovirus has rarely been reported as a cause of rhabdomyolysis and severe dysphagia with virus-induced rhabdomyolysis is also rare. Severe rhabdomyolysis often leads to acute renal failure, and this casereport shows that it may also cause severe dysphagia. Thus, swallowing assessment followed by suitable swallowing training could be recommended for those patients with viral-induced rhabdomyolysis with swallowing difficulties, helping improve or relieve the symptoms of swallowing disorders.

Language

Traditional Chinese

First Page

155

Last Page

161

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