title: Development of cytomegalovirus resistance to ganciclovir after oral maintenance treatment in a renal transplant recipient.
abstract: The emergence of a resistant strain is a theoretical threat after extensive use of antiviral drugs. We report the emergence of a ganciclovir-resistant cytomegalovirus (CMV) strain in a kidney transplant recipient during oral ganciclovir maintenance treatment. The patient was treated by oral ganciclovir for 2 months after successful treatment of CMV primary infection by intravenous ganciclovir. He developed a new episode of CMV infection with no clinical response to intravenous ganciclovir. The CMV isolate exhibited both phenotypic and genotypic resistance to ganciclovir. The CMV isolate was constituted of a mixture of strains, with and without a mutation at codon 460 of the UL97 gene. The clinical condition improved when mycophenolate mofetil (MMF) was discontinued, and a short course of intravenous globulin was added to ganciclovir. The emergence of the CMV strain could be secondary to more potent immunosuppression provide by MMF or subtherapeutic level obtained during oral ganciclovir treatment. We believe that ganciclovir resistance must be part of the differential diagnosis when a patient relapses or fails to respond to ganciclovir treatment.
authors.affiliation: Service de Néphrologie et de Virologie, Hôpital Saint Louis, Paris, France.
authors.forename: B
authors.initials: B
authors.lastname: Bienvenu
authors.forename: E
authors.initials: E
authors.lastname: Thervet
authors.forename: J
authors.initials: J
authors.lastname: Bedrossian
authors.forename: C
authors.initials: C
authors.lastname: Scieux
authors.forename: M C
authors.initials: MC
authors.lastname: Mazeron
authors.forename: D
authors.initials: D
authors.lastname: Thouvenot
authors.forename: C
authors.initials: C
authors.lastname: Legendre
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003587:Cytomegalovirus / Q000187:drug effects* / Q000502:physiology*; D003586:Cytomegalovirus Infections / Q000188:drug therapy / Q000821:virology; D004352:Drug Resistance, Microbial; D004359:Drug Therapy, Combination; D015774:Ganciclovir / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D016030:Kidney Transplantation; D008297:Male; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D011183:Postoperative Complications / Q000188:drug therapy; D012008:Recurrence
chemical_list: D000998:Antiviral Agents; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D015774:Ganciclovir