title: Trip to immunity: resistant cytomegalovirus infection in a lung transplant recipient.
abstract: We report the case of a young female lung transplant recipient with difficult-to-treat cytomegalovirus (CMV) disease. While treatment with intravenous (IV) ganciclovir failed due to antiviral drug resistance, a trial with foscarnet resulted in severe side effects. In addition, the patient received IV CMV-specific immune globulins as adjunctive therapy and leflunomide as experimental therapy. In this context, CMV-specific immune monitoring was performed and was successfully implemented in management decisions. The patient was screened for acquisition of an adaptive immune response, and antiviral prophylaxis and therapy was tailored according to results. This report highlights the impact of CMV-specific immune monitoring on individualized therapy for appropriate prophylaxis and management of CMV infection and diseases.
authors.affiliation: Department of Internal Medicine V, Comprehensive Pneumology Center, Member of the German Center for Lung Research, University of Munich, Marchioninistrasse 15, 81377 Munich, Germany. Electronic address: nikolaus.kneidinger@med.uni-muenchen.de.
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Kneidinger
authors.affiliation: Department of Internal Medicine III, University of Munich, Munich, Germany.
authors.forename: Clemens
authors.initials: C
authors.lastname: Giessen
authors.affiliation: Department of Internal Medicine V, Comprehensive Pneumology Center, Member of the German Center for Lung Research, University of Munich, Marchioninistrasse 15, 81377 Munich, Germany.
authors.forename: Werner
authors.initials: W
authors.lastname: von Wulffen
authors.affiliation: Department of Internal Medicine V, Comprehensive Pneumology Center, Member of the German Center for Lung Research, University of Munich, Marchioninistrasse 15, 81377 Munich, Germany.
authors.forename: Katrin
authors.initials: K
authors.lastname: Milger
authors.affiliation: Clinic of Cardiac Surgery, University of Munich, Munich, Germany.
authors.forename: René
authors.initials: R
authors.lastname: Schramm
authors.affiliation: Max von Pettenkofer-Institut, University of Munich, Munich, Germany.
authors.forename: Gundula
authors.initials: G
authors.lastname: Jäger
authors.affiliation: Max von Pettenkofer-Institut, University of Munich, Munich, Germany.
authors.forename: Hans
authors.initials: H
authors.lastname: Nitschko
authors.affiliation: Max von Pettenkofer-Institut, University of Munich, Munich, Germany.
authors.forename: Hannah
authors.initials: H
authors.lastname: Striebinger
authors.affiliation: Department of Internal Medicine V, Comprehensive Pneumology Center, Member of the German Center for Lung Research, University of Munich, Marchioninistrasse 15, 81377 Munich, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Behr
authors.affiliation: Department of Internal Medicine V, Comprehensive Pneumology Center, Member of the German Center for Lung Research, University of Munich, Marchioninistrasse 15, 81377 Munich, Germany.
authors.forename: Claus
authors.initials: C
authors.lastname: Neurohr
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D024882:Drug Resistance, Viral; D005260:Female; D017245:Foscarnet / Q000627:therapeutic use; D015774:Ganciclovir / Q000627:therapeutic use; D006801:Humans; D007136:Immunoglobulins / Q000627:therapeutic use; D016756:Immunoglobulins, Intravenous; D007555:Isoxazoles / Q000627:therapeutic use; D000077339:Leflunomide; D016040:Lung Transplantation; D015166:Monitoring, Immunologic; D066027:Transplant Recipients
chemical_list: D000998:Antiviral Agents; D007136:Immunoglobulins; D016756:Immunoglobulins, Intravenous; D007555:Isoxazoles; C045781:cytomegalovirus-specific hyperimmune globulin; D017245:Foscarnet; D000077339:Leflunomide; D015774:Ganciclovir
keywords: Cytomegalovirus; Ganciclovir resistance; Immune monitoring; Leflunomide; Transplantation