Treatment of Cytomegalovirus Infection with Cidofovir and CMV Immune Globulin in a Lung Transplant Recipient
Cytomegalovirus (CMV) infection after lung transplantation is associated with increased risk for pneumonitis and bronchiolitis obliterans as well as allograft rejection and opportunistic infections. Ganciclovir is the mainstay of prophylaxis and treatment but CMV infections can be unresponsive. Apar...
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| Format: | Article |
| Language: | English |
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Wiley
2016-01-01
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| Series: | Case Reports in Transplantation |
| Online Access: | http://dx.doi.org/10.1155/2016/4560745 |
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| author | Heinrike Wilkens Martina Sester |
| author_facet | Heinrike Wilkens Martina Sester |
| author_sort | Heinrike Wilkens |
| collection | DOAJ |
| description | Cytomegalovirus (CMV) infection after lung transplantation is associated with increased risk for pneumonitis and bronchiolitis obliterans as well as allograft rejection and opportunistic infections. Ganciclovir is the mainstay of prophylaxis and treatment but CMV infections can be unresponsive. Apart from direct antiviral drugs, CMV immunoglobulin (CMVIG) preparations may be considered but are only licensed for prophylaxis. A CMV-seronegative 42-year-old man with cystic fibrosis received a lung from a CMV-seropositive donor. Intravenous ganciclovir prophylaxis was delayed until day 12 due to acute postoperative renal failure and was accompanied by five doses of CMVIG (10 g). By day 16, CMV-DNA was detectable and rising; CMV-specific T-cells were undetectable. Switch from ganciclovir to foscarnet prompted a transient decrease in CMV viral load, but after increasing again to reach 3600 copies/mL foscarnet was changed to intravenous cidofovir and CMVIG was restarted. CMV load continued to fluctuate and declined slowly, whereas CMV-specific T-cells were detected five months later and increased thereafter. At last follow-up, the patient was in very good clinical condition with no evidence of bronchiolitis obliterans. No side effects of this treatment were observed. In this hard-to-treat case, the combination of cidofovir with off-label use of CMVIG contributed to a successful outcome. |
| format | Article |
| id | doaj-art-f15d79925b804ee78b952a0baeef75a1 |
| institution | Kabale University |
| issn | 2090-6943 2090-6951 |
| language | English |
| publishDate | 2016-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Transplantation |
| spelling | doaj-art-f15d79925b804ee78b952a0baeef75a12025-02-03T01:09:53ZengWileyCase Reports in Transplantation2090-69432090-69512016-01-01201610.1155/2016/45607454560745Treatment of Cytomegalovirus Infection with Cidofovir and CMV Immune Globulin in a Lung Transplant RecipientHeinrike Wilkens0Martina Sester1Department of Internal Medicine V-Pneumology, Allergology, Respiratory and Environmental Medicine, University Hospital of Saarland, Kirrbergerstrasse 100, Homburg, 66421 Saarland, GermanyDepartment of Transplant and Infection Immunology, Saarland University, Kirrbergerstrasse, Building 47, Homburg, 66421 Saarland, GermanyCytomegalovirus (CMV) infection after lung transplantation is associated with increased risk for pneumonitis and bronchiolitis obliterans as well as allograft rejection and opportunistic infections. Ganciclovir is the mainstay of prophylaxis and treatment but CMV infections can be unresponsive. Apart from direct antiviral drugs, CMV immunoglobulin (CMVIG) preparations may be considered but are only licensed for prophylaxis. A CMV-seronegative 42-year-old man with cystic fibrosis received a lung from a CMV-seropositive donor. Intravenous ganciclovir prophylaxis was delayed until day 12 due to acute postoperative renal failure and was accompanied by five doses of CMVIG (10 g). By day 16, CMV-DNA was detectable and rising; CMV-specific T-cells were undetectable. Switch from ganciclovir to foscarnet prompted a transient decrease in CMV viral load, but after increasing again to reach 3600 copies/mL foscarnet was changed to intravenous cidofovir and CMVIG was restarted. CMV load continued to fluctuate and declined slowly, whereas CMV-specific T-cells were detected five months later and increased thereafter. At last follow-up, the patient was in very good clinical condition with no evidence of bronchiolitis obliterans. No side effects of this treatment were observed. In this hard-to-treat case, the combination of cidofovir with off-label use of CMVIG contributed to a successful outcome.http://dx.doi.org/10.1155/2016/4560745 |
| spellingShingle | Heinrike Wilkens Martina Sester Treatment of Cytomegalovirus Infection with Cidofovir and CMV Immune Globulin in a Lung Transplant Recipient Case Reports in Transplantation |
| title | Treatment of Cytomegalovirus Infection with Cidofovir and CMV Immune Globulin in a Lung Transplant Recipient |
| title_full | Treatment of Cytomegalovirus Infection with Cidofovir and CMV Immune Globulin in a Lung Transplant Recipient |
| title_fullStr | Treatment of Cytomegalovirus Infection with Cidofovir and CMV Immune Globulin in a Lung Transplant Recipient |
| title_full_unstemmed | Treatment of Cytomegalovirus Infection with Cidofovir and CMV Immune Globulin in a Lung Transplant Recipient |
| title_short | Treatment of Cytomegalovirus Infection with Cidofovir and CMV Immune Globulin in a Lung Transplant Recipient |
| title_sort | treatment of cytomegalovirus infection with cidofovir and cmv immune globulin in a lung transplant recipient |
| url | http://dx.doi.org/10.1155/2016/4560745 |
| work_keys_str_mv | AT heinrikewilkens treatmentofcytomegalovirusinfectionwithcidofovirandcmvimmuneglobulininalungtransplantrecipient AT martinasester treatmentofcytomegalovirusinfectionwithcidofovirandcmvimmuneglobulininalungtransplantrecipient |