Cytomegalovirus encephalitis/retinitis in allogeneic haematopoietic stem cell transplant recipient treated successfully with combination of cidofovir and foscarnet

Abstract

We report an 18-yr-old female patient with repeated CMV reactivations after HSCT treated by several pre-emptive courses of virostatic therapy. Seven months after HSCT, she developed CMV encephalitis/retinitis. Initial therapy with GCV and hyperimmune globulin failed, and later on GCV-resistant strain was detected. Continual increase of CMV DNA in peripheral blood led us to combined therapy with CDV and FCV, which was successful and free of severe renal toxicity. To our best knowledge, this is the first reported case of successful CMV treatment with a combination of CDV and FCV.

A fatal case of cytomegalovirus ventriculoencephalitis in a mycosis fungoides patient who received multiple umbilical cord blood cell transplantations

“…Fourteen cases of CMV-induced central nervous system (CNS) disease have been reported (Table 1) [ [5][6][7][8][9][10][11][12][13][14][15][16][17]. Of published cases including ours, the median time of onset of CMV CNS disease was 185 days (range 107-285 days).…”

“…One survivor was treated with a 8 combination of FCV and CDV after initial therapy with GCV and i.v. Ig [12]. The other survivor received leflunomide, CDV, i.v.…”

Temporal and Spatial Compartmentalization of Drug-Resistant Cytomegalovirus (CMV) in a Child with CMV Meningoencephalitis: Implications for Sampling in Molecular Diagnosis

“…Whatever the hypothesis, our results show that blood samples may not be representative of the resistance status of the virus isolated in the CNS compartment. Interestingly, previous reports of CMV CNS diseases which compared the CMV genotypic resistance profiles in concomitant CSF and blood samples described similar profiles in the two compartments (6,11) or viral compartmentalization, with wild-type CMV in CSF samples and resistant CMV in blood and other sites (5,8,9,13). The authors suggested that decreased CMV fitness due to drug resistance mutations located in UL97 and/or UL54 genes could explain the predominance of wild-type strains in the CSF, even in cases of previous selection of resistant mutants in blood (17).…”

“…CMV infection of the central nervous system (CNS) is rare in HSCT recipients. Fifteen well-documented cases have been reported (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13). In most of them, the authors described a high viral load in the CSF contrasting with low peripheral blood viral load (2, 9, 13) or low antigenemia (3,4), suggesting a high level of viral replication in the CNS.…”

CMV central nervous system disease in stem-cell transplant recipients: an increasing complication of drug-resistant CMV infection and protracted immunodeficiency

“…This review yielded nine cases of CMV CNS disease in SCT recipients, which meet the criteria for CMV disease of the CNS. [4][5][6][7][8][9][10][11][12] Data from these nine cases along with the two UCLA cases (a total of 11 patients) are summarized in Table 1. Except for one pediatric patient, all patients were adults (median age, 46 years).…”