title: Fatal lactic acidosis possibly related to ganciclovir therapy in a renal transplant patient?
abstract: Ganciclovir is widely prescribed in renal transplant patients for the prevention or treatment of herpes and cytomegalovirus (CMV) infections. Side-effects are usually represented by hematological disorders, and particularly leucopenia. We report a case of severe and fatal lactic acidosis developing in a 76-year-old renal transplant woman, a few days after ganciclovir has been introduced to treat CMV pneumonia. Usual etiologies of lactic acidosis were ruled out. A high lactate/pyruvate molecular ratio was suggestive of a respiratory chain dysfunction. With the analogy to nucleoside analogues-related lactic acidosis, we suggest that ganciclovir may exceptionally be responsible for respiratory chain dysfunction and subsequent lactic acidosis, and we discuss potential risk factors in our patient.
authors: Department of Intensive Care, Cliniques St-Luc, Université catholique de Louvain, Brussels, Belgium.
authors: Xavier
authors: X
authors: Wittebole
authors: Department of Nephrology, Cliniques St-Luc, Université catholique de Louvain, Brussels, Belgium.
authors: Johann
authors: J
authors: Morelle
authors: Department of Biochemistry, Cliniques St-Luc, Université catholique de Louvain, Brussels, Belgium.
authors: Marie-Françoise
authors: MF
authors: Vincent
authors: Department of Intensive Care, Cliniques St-Luc, Université catholique de Louvain, Brussels, Belgium ; Louvain Centre for Toxicology and Applied Pharmacology, Université catholique de Louvain, Brussels, Belgium.
authors: Philippe
authors: P
authors: Hantson
keywords: Ganciclovir; lactic acidosis; renal transplant