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2018•Journal of Clinical and Experimental TransplantationOpen access

Utilizing UL97 Resistant Codon Specificities to Guide Pharmacotherapy Treatment Decisions in Resistant Cytomegalovirus Infections

Angela Q. Maldonado, David B. Leeser, Tomefa E. Asempa

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Abstract

The development of cytomegalovirus (CMV) drug resistance has become an emerging clinical challenge. In kidney transplant recipients (KTR), CMV infection is a risk factor for acute rejection, has a detrimental effect on patient survival, and predisposes patients to secondary opportunistic infections. We report here the case of a kidney transplant patient on valganciclovir prophylaxis who developed recurrent CMV infections, complicated by UL97 ganciclovir (GCV) resistance. Our patient underwent unsuccessful treatment courses with high dose GCV, foscarnet and cidofovir. Compassionate use maribavir was initiated and resulted in full recovery. Through this case report and literature review, we highlight potential strategies for the successful management of CMV resistance.

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What this paper is about

The development of cytomegalovirus (CMV) drug resistance has become an emerging clinical challenge. In kidney transplant recipients (KTR), CMV infection is a risk factor for acute rejection, has a detrimental effect on patient survival, and predisposes patients to secondary opportunistic infections. We report here the case of a kidney transplant patient on valganciclovir prophylaxis who developed recurrent CMV infections, complicated by UL97 ganciclovir (GCV) resistance. Our patient underwent unsuccessful treatment courses with high dose GCV, foscarnet and cidofovir. Compassionate use maribavir was initiated and resulted in full recovery. Through this case report and literature review, we highlight potential strategies for the successful management of CMV resistance.

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Available abstract

The development of cytomegalovirus (CMV) drug resistance has become an emerging clinical challenge. In kidney transplant recipients (KTR), CMV infection is a risk factor for acute rejection, has a detrimental effect on patient survival, and predisposes patients to secondary opportunistic infections. We report here the case of a kidney transplant patient on valganciclovir prophylaxis who developed recurrent CMV infections, complicated by UL97 ganciclovir (GCV) resistance. Our patient underwent unsuccessful treatment courses with high dose GCV, foscarnet and cidofovir. Compassionate use maribavir was initiated and resulted in full recovery. Through this case report and literature review, we highlight potential strategies for the successful management of CMV resistance.

Key concepts: Cidofovir, Valganciclovir, Foscarnet, Ganciclovir, Medicine, Cytomegalovirus, Drug resistance, Intensive care medicine

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Utilizing UL97 Resistant Codon Specificities to Guide Pharmacotherapy Treatment Decisions in Resistant Cytomegalovirus Infections — Research Paper | ScholarLens