Ganciclovir and Foscarnet Therapy of Cytomegalovirus-Associated Meningoencephalitis in a Hemodialysis Patient With Liver Transplantation: Case Report.
Cytomegalovirus (CMV) infection in patients with liver transplantation (LT) remains a highly prevalent complication with a significant increase in morbidity and mortality. However, CMV-associated meningoencephalitis is rarely diagnosed, and treatment is very difficult. The aim of the present report is to review the experience of successful treatment with combined ganciclovir and foscarnet of CMV-associated meningoencephalitis refractory to ganciclovir alone in a hemodialysis (HD) patient after LT. A 54-year-old woman with end-stage renal disease on HD developed a seizure with loss of consciousness. She had received a liver transplant 4 months before. Blood CMV polymerase chain reaction was positive, and cerebrospinal fluid (CSF) analysis was compatible with viral meningitis. Brain magnetic resonance imaging (MRI) showed extensive dural thickening with enhancement and a round ring-like enhancement in the left centrum semiovale. She was diagnosed with CMV-associated meningoencephalitis. At that time, ganciclovir was started intravenously. After that, there were no improvements in mental state, CSF analysis, or brain MRI. Intravenous foscarnet at reduced dose was added to ganciclovir therapy. With combined ganciclovir and foscarnet, there was a slight improvement in her mental state and brain MRI.
Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea. Electronic address: gwkang4540@hanmail.net.
G W
GW
Kang
Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea.
H L
HL
Hong
Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea.
I H
IH
Lee
Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea.
K S
KS
Ahn
Department of General Surgery, Catholic University of Daegu School of Medicine, Daegu, Korea.
J D
JD
Kim
Department of General Surgery, Catholic University of Daegu School of Medicine, Daegu, Korea.
D L
DL
Choi
D000998:Antiviral Agents / Q000627:therapeutic use*; D003587:Cytomegalovirus / Q000235:genetics; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D004359:Drug Therapy, Combination; D005260:Female; D017245:Foscarnet / Q000627:therapeutic use*; D015774:Ganciclovir / Q000627:therapeutic use*; D006084:Graft Rejection / Q000517:prevention & control*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D016031:Liver Transplantation; D008590:Meningoencephalitis / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D006435:Renal Dialysis
D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D017245:Foscarnet; D015774:Ganciclovir