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Resistance to combined ganciclovir and foscarnet therapy in a liver transplant recipient with possible dual-strain cytomegalovirus coinfection
Liver Transplantation
  • John Rodriguez
  • Katherine Casper
  • Gregory Smallwood, Philadelphia College of Osteopathic Medicine
  • Andrei Stieber
  • Carlos Fasola
  • Jennifer Lehneman
  • Thomas Heffron
Document Type
Article
Publication Date
1-1-2007
Abstract
We present a case report of a cytomegalovirus (CMV)-seronegative, 58-year-old male who received a CMV-seropositive donor liver transplant without CMV prophylaxis. On postoperative day 30, the patient developed primary CMV disease that responded to ganciclovir. On postoperative day 114, however, he was diagnosed with recurrent CMV infection. Despite aggressive, combined antiviral treatment with ganciclovir and foscamet and reduction of immunosuppression, viral clearance was never achieved. Serum samples were collected throughout the infectious process for viral DNA analysis. Portions of the UL97 and UL54 genes were amplified and compared to the AD169 wild-type strain. Sequencing studies revealed the presence of mutations in viral isolates obtained after clinical resistance was observed. These mutations were not present in samples obtained during the primary CMV infection. Our findings suggest the presence of coinfection with at least 2 different strains of CMV rather than induction of mutations after ganciclovir therapy. © 2007 AASLD.
Comments

This article was published in Liver Transplantation, Volume 13, Issue 10, Pages 1396-1400.

The published version is available at http://dx.doi.org/10.1002/lt.21245.

Copyright © 2007 Wiley.

Citation Information
John Rodriguez, Katherine Casper, Gregory Smallwood, Andrei Stieber, et al.. "Resistance to combined ganciclovir and foscarnet therapy in a liver transplant recipient with possible dual-strain cytomegalovirus coinfection" Liver Transplantation Vol. 13 Iss. 10 (2007) p. 1396 - 1400
Available at: http://works.bepress.com/gregory_smallwood/17/