title: Utility of Leflunomide in the Treatment of Drug Resistant Cytomegalovirus Retinitis.
abstract: OBJECTIVE
  To describe leflunomide use in the treatment of drug resistant cytomegalovirus retinitis. Leflunomide has been shown to be effective in the treatment of systemic CMV viremia.
  
  
  METHODS
  Retrospective chart review of patients with CMV retinitis treated with leflunomide.
  
  
  RESULTS
  Two HIV-negative organ transplant recipients with UL 97 mutation resistant-genotype CMV were identified. Patient 1 developed CMV viremia post-kidney transplant and subsequently bilateral CMV retinitis. Retinitis progressed, despite intravitreal injection of ganciclovir and foscarnet, and IV foscarnet and oral valganciclovir. Retinitis control was achieved with the addition of oral leflunomide. Disease remained inactive for 22 months. Patient 2 developed CMV retinitis after lung transplant. Disease progressed despite intravitreal foscarnet injections and oral valganciclovir. Control of retinitis was achieved with addition of oral leflunomide, allowing cessation of intravitreal therapy. Disease remained inactive until his death.
  
  
  CONCLUSIONS
  Leflunomide may be considered as a treatment option for resistant CMV retinitis.
authors.affiliation: a Department of Ophthalmology , Northwestern University, Feinberg School of Medicine , Chicago , Illinois , USA.
authors.forename: Lana M
authors.initials: LM
authors.lastname: Rifkin
authors.affiliation: a Department of Ophthalmology , Northwestern University, Feinberg School of Medicine , Chicago , Illinois , USA.
authors.forename: Caroline L
authors.initials: CL
authors.lastname: Minkus
authors.affiliation: b Department of Infectious Disease , University of Chicago , Chicago , Illinois , USA.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Pursell
authors.affiliation: a Department of Ophthalmology , Northwestern University, Feinberg School of Medicine , Chicago , Illinois , USA.
authors.forename: Chaisiri
authors.initials: C
authors.lastname: Jumroendararasame
authors.affiliation: a Department of Ophthalmology , Northwestern University, Feinberg School of Medicine , Chicago , Illinois , USA.
authors.forename: Debra A
authors.initials: DA
authors.lastname: Goldstein
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use; D003587:Cytomegalovirus / Q000235:genetics; D017726:Cytomegalovirus Retinitis / Q000188:drug therapy*; D024882:Drug Resistance, Viral; D005838:Genotype; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D058449:Intravitreal Injections; D007555:Isoxazoles / Q000627:therapeutic use*; D016030:Kidney Transplantation; D000077339:Leflunomide; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014766:Viremia / Q000188:drug therapy*
chemical_list: D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D007555:Isoxazoles; D000077339:Leflunomide
keywords: Arava; CMV retinitis; drug resistant; treatment; viremia