Management of Cytomegalovirus Infection in a Patient with Malignant Glioma Treated with Temozolomide and Steroids

Abstract

Temozolomide (TMZ) is the standard chemotherapy treatment for glioblastoma. Lymphocytopenia is reported to be the most frequent and severe adverse effect of TMZ and leads to opportunistic infections. Few cases of TMZ-induced cytomegalovirus (CMV) reactivation have so far been reported, and there are no guidelines regarding the use of chemotherapy after recovery from CMV reactivation. We herein report the case of a 45-year-old man with glioblastoma who developed CMV hepatitis following surgery and chemoradiotherapy with concomitant TMZ and steroids. After successful treatment of the CMV infection with an antiviral agent and recovery from the lymphocytopenia were achieved, the patient resumed maintenance therapy with TMZ under careful monitoring of his lymphocyte count and CMV pp65 antigenemia level.

Cytomegalovirus Hemorrhagic Cystitis in a Malignant Glioma Patient Treated with Temozolomide

“…At the development of CMV infection, their absolute lymphocyte count ranged from 60 to 703, and their CD4 + T-cell count ranged from 36 to 260. The reported manifestations of CMV infections are various and include pneumonitis ( 12 , 16 ), colitis ( 12 , 13 ), colonic pseudotumor ( 15 ), transverse myelitis ( 13 ), and hepatitis ( 17 ).…”

Cytomegalovirus esophagitis developing during chemoradiotherapy for esophageal cancer: two case reports

“…CMV infection in patients with esophageal cancer may be underreported, because fever and gastrointestinal symptoms in such patients may not be attributed to CMV infection, and instead simply managed as symptoms of radiation esophagitis or side effects of chemoradiotherapy. Severe lymphocytopenia as well as low WBC counts and neutropenia may lead to CMV esophagitis during chemoradiotherapy [ 7 , 8 ].…”

Frequent occurrence of therapeutically reversible cmv-associated encephalopathy during radiotherapy of the brain.

“…1 However, there have been few reports of glioblastoma patients suffering reactivation of CMV during chemotherapy with temozolomide. 2 In addition, glioblastoma patients are suspected to have higher prevalence of positivity for anti-CMV immunoglobulin (Ig)G 3,4 compared with the healthy population. 5,6 As of yet, there has been no proven connection between occurrence of CMV infection and glioblastoma.…”