Management of Ganciclovir Resistant Cytomegalovirus Retinitis in a Solid Organ Transplant Recipient: A Review of Current Evidence and Treatment Approaches. (2nd October 2020)

• Record Type: Journal Article
• Authors: Fu, L.; Santhanakrishnan, K.; Al-Aloul, M.; Jones, N. P.; Steeples, L. R.
• Is Part Of: Ocular immunology and inflammation. Volume 28:Number 7(2020)
• Page Start: 1152
• Page End: 1158
• Publication Date: 2020-10-02
• Subjects: Cytomegalovirus (CMV) retinitis -- drug-resistance -- ganciclovir-resistance -- immunoglobulins -- UL97; Eye -- Diseases -- Immunological aspects -- Periodicals; Eye -- Inflammation -- Periodicals; 617.7
• DOI: 10.1080/09273948.2019.1645188
• Languages: English
• ISSNs: 0927-3948

Abstract

ABSTRACT: Purpose : Cytomegalovirus retinitis (CMVR) is a serious and potentially sight-threatening infection in immunocompromised individuals. Strategies for the management of drug-resistant CMVR are described. Methods : A case of severe bilateral CMVR in a single lung transplant patient, with UL97 mutation conferring ganciclovir-resistance, is presented. Treatment with standard antiviral agent and adjuvant leflunomide, immunosuppression modifications (calcineurin inhibitors and corticosteroid), intravitreal antiviral therapy and novel use of CMV-immunoglobulin is described. A literature review to support drug-resistant CMVR management is presented. Results : Severe and progressive CMV retinitis was refractory to intravitreal foscarnet and systemic leflunomide. Drug-toxicity restricted systemic antiviral therapy options. The use of combined leflunomide and CMV-immunoglobulins, in the absence of viremia, has not been previously reported. Loss of ganciclovir-resistance was eventually observed permitting successful treatment with systemic and intravitreal ganciclovir. Conclusions : Drug-resistant CMVR is a complex clinical challenge. Multiple systemic and local treatment strategies may be necessary but toxicity, resistance, and co-morbidities may severely restrict available options.