Sequential treatment of cytomegalovirus infection or disease with a short course of intravenous ganciclovir followed by oral valganciclovir: efficacy, safety, and pharmacokinetics

A 44-year-old man with a history of renal transplantation presented with right lower abdominal wall swelling, redness and pain. A bacterial abscess was drained, and he was discharged home with oral antibiotics. After failing to improve, he returned to the hospital, where he was briefly treated with intravenous antibiotics and discharged home again. The patient returned 5 days later, reporting worsening right groin swelling that extended into the ipsilateral scrotum. Imaging revealed a persistent fluid collection in the region, and he was taken for surgical debridement. Tissue immunochemistry and histopathological evaluation identified cytomegalovirus infection. Plasma quantitative PCR for cytomegalovirus demonstrated high viraemia. The patient was successfully treated with intravenous ganciclovir, followed by oral valganciclovir, with resolution of the skin changes. Persistent hydrocele with epididymitis on imaging suggests that this process may have been the source of the cutaneous cytomegalovirus infection.

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Incidence, Risk Factors, and Outcome of Cytomegalovirus Infection and Disease in Patients Receiving Prophylaxis with Oral Valganciclovir or Intravenous Ganciclovir after Umbilical Cord Blood Transplantation

Biology of Blood and Marrow Transplantation ◽

10.1016/j.bbmt.2009.03.002 ◽

2009 ◽

Vol 15 (6) ◽

pp. 730-740 ◽

Cited By ~ 40

Author(s):

Pau Montesinos ◽

Jaime Sanz ◽

Susana Cantero ◽

Ignacio Lorenzo ◽

Guillermo Martín ◽

...

Keyword(s):

Risk Factors ◽

Cord Blood ◽

Umbilical Cord Blood ◽

Cytomegalovirus Infection ◽

Cord Blood Transplantation ◽

Umbilical Cord Blood Transplantation ◽

Intravenous Ganciclovir ◽

Blood Transplantation ◽

Incidence Risk ◽

Oral Valganciclovir

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High efficacy and low toxicity of short-course oral valganciclovir as pre-emptive therapy for hematopoietic stem cell transplant cytomegalovirus infection

Hematology/Oncology and Stem Cell Therapy ◽

10.1016/s1658-3876(10)50021-9 ◽

2010 ◽

Vol 3 (3) ◽

pp. 116-120 ◽

Cited By ~ 10

Author(s):

A.J.M. Saleh ◽

Fahad Al Mohareb ◽

Fahad Al Rabiah ◽

Naeem Chaudhri ◽

Fahad Al Sharif ◽

...

Keyword(s):

Stem Cell ◽

Cytomegalovirus Infection ◽

Hematopoietic Stem Cell Transplant ◽

Stem Cell Transplant ◽

Cell Transplant ◽

High Efficacy ◽

Hematopoietic Stem ◽

Short Course ◽

Oral Valganciclovir ◽

Low Toxicity

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CMV pneumonitis in a patient with Crohn’s disease taking azathioprine

BMJ Case Reports ◽

10.1136/bcr-2020-241256 ◽

2021 ◽

Vol 14 (4) ◽

pp. e241256

Author(s):

Timothy Zef Hawthorne ◽

Rachel Shellien ◽

Lucy Chambers ◽

Graham Devereux

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Low Dose ◽

Antiviral Treatment ◽

Cmv Infection ◽

Rare Presentation ◽

Intravenous Ganciclovir ◽

Increased Risk ◽

Oral Valganciclovir

This case report discusses the rare presentation of cytomegalovirus (CMV) pneumonitis in a young patient with moderately severe Crohn’s disease managed with low dose azathioprine. CMV pneumonitis was initially suspected on CT chest images and confirmed by PCR for CMV. She was treated with intravenous ganciclovir and later stepped down to oral valganciclovir. Although this patient had a prolonged and complicated hospital admission, a good clinical outcome was achieved. CMV infection was raised as an early differential and antiviral treatment was started without delay. This case study, therefore, makes the case for increased awareness of the possibility of, and recognition of CMV pneumonitis among healthcare professionals as a way of preventing significant morbidity and mortality. It also raises awareness of checking for slow metabolisers of azathioprine before initiation to look for individuals who may be at increased risk of azathioprine’s adverse effects.

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