-
Ocular Immunology and Inflammation Mar 2024To report a rare case of cytomegalovirus (CMV)-associated non-necrotizing viral retinopathy, occlusive retinal vasculitis, papillitis, and retinal neovascularization in...
PURPOSE
To report a rare case of cytomegalovirus (CMV)-associated non-necrotizing viral retinopathy, occlusive retinal vasculitis, papillitis, and retinal neovascularization in a young 41-year-old woman.
METHODS
Case report.
RESULTS
The patient presented with features of papillitis, peripapillary cotton-wool spots, pre-retinal hemorrhages, and occlusive vasculitis. Her visual acuity was 20/100 in the left eye. She developed a worsening of the disease upon initiation of systemic corticosteroids. Her serum immunoglobulins (Ig) (both IgG and IgM) were highly positive for CMV. Anterior chamber paracentesis was positive for CMV DNA using real-time polymerase chain reaction. After stopping systemic corticosteroids, she was initiated on oral valganciclovir, with rapid resolution of the vasculitis and cotton-wool spots. After three months, the patient developed retinal neovascularization and underwent pan-retinal photocoagulation. However, her uveitis was inactive, and her visual acuity improved to 20/25.
CONCLUSIONS
Non-necrotizing viral retinopathy has been associated with either varicella zoster virus (VZV) or herpes simplex virus (HSV). Our case highlights that CMV can also lead to non-necrotizing retinopathy and must be suspected in patients who may be negative for VZV and HSV. Appropriate anti-viral treatment can prevent severe vision loss in these patients.
PubMed: 38436937
DOI: 10.1080/09273948.2024.2325054 -
Ocular Immunology and Inflammation Aug 2023Acute retinal necrosis (ARN) is a severe eye disease demanding swift treatment to prevent blindness. Early action involving antiviral medications and corticosteroids is...
INTRODUCTION
Acute retinal necrosis (ARN) is a severe eye disease demanding swift treatment to prevent blindness. Early action involving antiviral medications and corticosteroids is crucial for optimal visual outcomes.
OBJECTIVE
We present an ARN case series showcasing treatment experience and results.
METHODOLOGY
Patients diagnosed with ARN based on SUN Working Group 2021 criteria were included; all underwent comprehensive eye exams, PCR analysis, and imaging.
RESULTS
Eight patients were studied; PCR confirmed ARN in six. Induction treatment, either oral valacyclovir (5/8) or intravenous acyclovir (3/8), lasted 10-14 days. Maintenance included oral valacyclovir (6/8), oral valganciclovir (2/8) for six months, along with intravitreal ganciclovir. Visual outcomes were similar for oral and intravenous therapies; poor baseline acuity and macular involvement tend to result in a worse final acuity.
CONCLUSIONS
Swift treatment is vital to ARN management. Our findings emphasize effective treatment strategies' role in visual prognosis.
ABBREVIATIONS
ACV: Acyclovir; BCVA: Best Corrected Visual Acuity; CMV: Cytomegalovirus; EBV: Epstein Barr Virus; FTA-ABS: Fluorescent treponemal antibody absorption test; HSV 1-2: Herpes simplex virus 1-2; HIV: Human Immunodeficiency Virus; IV-ACV: Intravenous- Acyclovir; PCR: Polymerase Chain Reaction;Tg: ; VZV: Varicella Zoster Virus; VCV: Valacyclovir; VDRL: Venereal disease research laboratory test.
PubMed: 37582226
DOI: 10.1080/09273948.2023.2244076 -
Transplant Infectious Disease : An... Aug 2023Cytomegalovirus (CMV) infection is one of the most common posttransplantation infections and has been associated with increased rejection and mortality. Data in...
BACKGROUND
Cytomegalovirus (CMV) infection is one of the most common posttransplantation infections and has been associated with increased rejection and mortality. Data in intestinal transplants recipients are limited.
METHODS
This is a single-center, retrospective cohort study of all intestinal transplants performed between January 1, 2009, and August 31, 2020. We included recipients of all ages who were at risk of CMV infection. To identify the risk factors, we conducted at first univariate and multivariate analysis. For the multivariate analysis, we developed a logistic regression model based on the result of univariate analysis.
RESULTS
Ninety five patients with a median age of 32 (interquartile range [IQR] 4, 50) were included. CMV donor seropositive/recipient seronegative were 17 (17.9%). Overall, 22.1% of the recipients developed CMV infection at a median time of 155 (IQR 28-254) days from transplant, including 4 CMV syndrome and 6 CMV end-organ disease. Overall, 90.4%, (19/21) developed DNAemia while on prophylaxis. Median peak viral load and time to negativity was 16 000 (IQR 1034-43 892) IU/mL and 56 (IQR 49-109) days, respectively. (Val)ganciclovir and foscarnet were utilized in 17 (80.9%) and 1 (4.76%) recipients, respectively. Recurrences of CMV DNAemia and graft rejection were observed in three and six recipients, respectively. Younger age was identified as a risk factor (p = .032, odds ratio 0.97, 95% confidence interval 0.95-0.99) to develop CMV DNAemia.
CONCLUSION
A significant proportion of intestinal transplant recipients developed CMV infection while on prophylaxis. Better methods such as CMV cell mediated immunity guided prophylaxis should be used to prevent infections in this population.
PubMed: 37196056
DOI: 10.1111/tid.14071 -
Case Reports in Medicine 2023Cytomegalovirus (CMV) infection is a widespread condition that can affect individuals of all ages. Most cases of CMV infection are mild and resolve on their own....
INTRODUCTION
Cytomegalovirus (CMV) infection is a widespread condition that can affect individuals of all ages. Most cases of CMV infection are mild and resolve on their own. However, in immunocompromised individuals, such as post-transplant patients or those with cancer, severe infections can occur. While there have been several studies on CMV infection in post-transplant patients, there is limited literature on CMV infection in cancer, particularly in kidney cancer. . In this case report, we present the case of a 61-year-old man with clear cell renal cell carcinoma who underwent targeted therapy with the receptor tyrosine kinase (RTK) inhibitor lenvatinib and the mammalian target of rapamycin (mTOR) inhibitor everolimus. The patient was hospitalized for 26 days and admitted to the intensive care unit (ICU) due to shortness of breath, decreased oxygen saturation, and irregular breathing. Cytomegalovirus polymerase chain reaction (PCR) test results were positive. Given the high prevalence of CMV infection in developing countries, it is likely that the patient had a reactivation of CMV. As such, the patient was subsequently treated with ganciclovir for 14 days and showed improvement in symptoms such as shortness of breath, cough, fever, and increased oxygen saturation. Following recovery, the patient received maintenance therapy with oral valganciclovir for 7 days. No further symptoms appeared during subsequent cancer treatments.
CONCLUSION
Cancer patients who are undergoing treatment are at a higher risk for developing opportunistic infections, which can result in morbidity and mortality. Therefore, healthcare professionals should be aware of the possibility of CMV infection in cancer patients and be prepared to diagnose and treat the infection, particularly in areas where the prevalence of CMV infection is high.
PubMed: 38023618
DOI: 10.1155/2023/5560673 -
European Journal of Ophthalmology Sep 2023Belatacept is associated with a higher incidence of cytomegalovirus (CMV) disease and atypical presentations. Ocular manifestations are rare, representing up to 5% of...
INTRODUCTION
Belatacept is associated with a higher incidence of cytomegalovirus (CMV) disease and atypical presentations. Ocular manifestations are rare, representing up to 5% of disease manifestations and previous cases consisted in isolated retinitis.
CASE DESCRIPTION
Herein, we report the case of an 81-year-old kidney transplant recipient who developed an anterior and intermediate uveitis under belatacept therapy. The diagnosis was established using quantitative CMV polymerase chain reaction assays in the aqueous humor. Belatacept was interrupted and oral and topical valganciclovir treatments were instituted. Lesions however extended, leading to intensify the treatment by intra-venous and intra-vitreal ganciclovir injections. Visual acuity stabilized and ocular inflammation was finally controlled after 3 months.
CONCLUSION
Clinicians should be aware of CMV infection as a cause of anterior uveitis under belatacept-based regimen, even in the absence of symptoms suggestive of systemic CMV replication.
Topics: Humans; Aged, 80 and over; Antiviral Agents; Abatacept; Kidney Transplantation; Ganciclovir; Cytomegalovirus Infections; Uveitis, Anterior; Uveitis, Intermediate
PubMed: 36112857
DOI: 10.1177/11206721221126308 -
British Journal of Clinical Pharmacology Jun 2024Cytomegalovirus (CMV) infection frequently occurs after solid organ transplantation and is associated with an increased morbidity and mortality. Fortunately, the...
Cytomegalovirus (CMV) infection frequently occurs after solid organ transplantation and is associated with an increased morbidity and mortality. Fortunately, the development of valganciclovir prophylaxis has lowered the incidence of CMV infection and its complications in immunosuppressed solid organ transplant recipients. However, breakthrough infections during valganciclovir prophylaxis and late CMV infection after cessation of valganciclovir prophylaxis still occur with the current prophylactic strategy. Additionally, valganciclovir resistance has emerged among CMV strains, which complicates the treatment of CMV infections. Furthermore, the use of valganciclovir is associated with myelotoxicity, which can lead to the premature withdrawal of prophylaxis. It is important to address these current issues in order to improve the standard care after solid organ transplantation. This paper will therefore discuss the clinical practice of valganciclovir prophylaxis, elaborate on its issues and suggest how to improve the current prophylactic strategy with a possible role for therapeutic drug monitoring.
PubMed: 38889884
DOI: 10.1111/bcp.16138 -
Transplant Infectious Disease : An... Feb 2024Cytomegalovirus (CMV) infections are a common complication after kidney transplantation (KTx) and negatively affecting patient outcome. Valganciclovir (VGC) prophylaxis...
BACKGROUND
Cytomegalovirus (CMV) infections are a common complication after kidney transplantation (KTx) and negatively affecting patient outcome. Valganciclovir (VGC) prophylaxis is often limited by drug-induced side effects and dose reduction due to decline in kidney function.
METHOD
In the present study, episodes of CMV viremia in the first year after KTx in a cohort of 316 recipients were analyzed retrospectively to identify risk factors linked to persistent infections.
RESULTS
In the studied cohort, 18.7% of patients showed a high-risk (HR) constellation (D+/R-) for CMV infections. CMV viremia affected 22% of our cohort, with HR patients being the most affected cohort (44.1%). Within this group, most viremic events (65.3%) occurred while patients were still on prophylactic therapy, showing significantly higher viral loads and a longer duration compared to seropositive recipients.
CONCLUSION
The analysis at hand revealed that detection of viremia under ongoing antiviral prophylaxis bears an increased risk for sustained viral replication and antiviral drug resistance in HR patients. We identified low estimated glomerular filtration rate (eGFR) and lower dose VGC prophylaxis post-KTx as a risk factor for breakthrough infections in HR patients in our single center cohort. These patients might benefit from a closer CMV monitoring or novel prophylactic agents as letermovir.
Topics: Humans; Antiviral Agents; Cytomegalovirus; Kidney Transplantation; Retrospective Studies; Viremia; Cytomegalovirus Infections; Valganciclovir; Transplant Recipients; Ganciclovir
PubMed: 38180168
DOI: 10.1111/tid.14233 -
Cureus Aug 2023Cytomegalovirus (CMV) is one of the most frequent microbes linked with kidney transplant recipients. CMV infection is typically classified as CMV virus isolation in any...
Cytomegalovirus (CMV) is one of the most frequent microbes linked with kidney transplant recipients. CMV infection is typically classified as CMV virus isolation in any body fluid or specimen. We present a 43-year-old man who underwent a deceased donor kidney transplant with CMV donor-seronegative and recipient-seronegative (CMV D-/R-) status and completed three months of CMV prophylaxis with high-dose acyclovir given his low-risk status. He was admitted for complaints of profuse watery diarrhea and persistent fevers lasting one week in duration. His infectious workup led to a CMV quantitative nucleic acid amplification test (QNAT) polymerase chain reaction (PCR) of 239,977 IU/mL with a biopsy-proven diagnosis of invasive CMV colitis. He was treated inpatient with intravenous ganciclovir for two weeks and then de-escalated to oral valganciclovir until achieving viremia resolution with undetectable CMV QNAT PCR as an outpatient. This case illustrates the importance of the changing epidemiology and clinical presentation of CMV disease in solid organ transplant (SOT) recipients in an era of new immunosuppression regimens and improved CMV disease detection in the early post-transplant period.
PubMed: 37719577
DOI: 10.7759/cureus.43509 -
Leukemia & Lymphoma Jun 2024Cytomegalovirus (CMV) reactivation increases treatment-related mortality (TRM) after allogeneic hematopoietic cell transplantation (allo-HCT). We analyzed 141 adult... (Comparative Study)
Comparative Study
Cytomegalovirus (CMV) reactivation increases treatment-related mortality (TRM) after allogeneic hematopoietic cell transplantation (allo-HCT). We analyzed 141 adult acute leukemia (AL) patients suffered allo-HCT between 2017 and 2021, who developed CMV viremia post-HCT and treated with valganciclovir or foscarnet, to evaluate effectiveness and safety of both drugs. Viremia clearance rates (14 and 21 d post treatment) and toxicities were similar in two groups. However, valganciclovir was associated with a lower cumulative incidence of CMV recurrence within 180 days (16.7% vs. 35.7%, =0.029) post CMV clearance. Finally, 2-year TRM was lower in valganciclovir group (9.7% ± 0.2% 26.2% ± 0.3%, = 0.026), result a superior 2-year overall survival (OS; 88.1% ± 5.2% 64.4% ± 5.5%, = 0.005) and leukemia-free survival (LFS; 82.0% ± 5.9% 58.9% ± 5.6%, = 0.009). Valganciclovir might decrease CMV viremia recurrence and led to better long-term outcome than foscarnet in adult AL patients developed CMV viremia post-HCT. Considering the inherent biases of retrospective study, well-designed trials are warranted to validate our conclusion.
Topics: Humans; Hematopoietic Stem Cell Transplantation; Cytomegalovirus Infections; Valganciclovir; Male; Female; Viremia; Adult; Antiviral Agents; Foscarnet; Middle Aged; Transplantation, Homologous; Cytomegalovirus; Retrospective Studies; Young Adult; Aged; Leukemia, Myeloid, Acute; Treatment Outcome; Leukemia
PubMed: 38475670
DOI: 10.1080/10428194.2024.2321322 -
Transplant Infectious Disease : An... Dec 2023Valganciclovir is the first-line agent for Cytomegalovirus prophylaxis after lung transplantation. However, its use is associated with a relatively high risk of... (Observational Study)
Observational Study
BACKGROUND
Valganciclovir is the first-line agent for Cytomegalovirus prophylaxis after lung transplantation. However, its use is associated with a relatively high risk of hematological toxicity. This study aimed to investigate the relationship between trough ganciclovir concentration and hematologic toxicity in lung transplantation patients receiving valganciclovir prophylaxis, and identify factors that affect ganciclovir pharmacokinetics in this population.
METHODS
This prospective observational study included 24 lung transplant patients receiving valganciclovir prophylaxis. The cutoff value of trough ganciclovir concentration was estimated using receiver operating characteristic analysis in leukopenia grade 3 and higher. Population pharmacokinetic analysis was performed using a nonlinear mixed-effects modeling program.
RESULTS
The trough ganciclovir concentration was significantly higher in the group with leukopenia grades 3 or higher than in the group with grades less than or equal to 2 (1605.7 ± 860.1 ng/mL [n = 3] vs. 380.5 ± 175.8 ng/mL (n = 21), p < .001). The cutoff value of trough ganciclovir concentration for predicting greater than or equal to grade 3 leukopenia was estimated as 872.0 ng/mL. Creatinine clearance and lung re-transplantation were found to have a significant impact on the total body clearance of valganciclovir. Ganciclovir clearance was decreased in patients with reduced creatine clearance or re-transplantation.
CONCLUSION
These results suggest that higher ganciclovir trough concentrations are associated with an increased risk of leukopenia grade 3 or higher, and that creatinine clearance and lung re-transplantation affected the pharmacokinetics of ganciclovir.
Topics: Humans; Ganciclovir; Valganciclovir; Antiviral Agents; Transplant Recipients; Creatinine; Cytomegalovirus Infections; Lung; Leukopenia
PubMed: 37639301
DOI: 10.1111/tid.14141