CMV Viremia and Colitis in Simultaneous Pancreas-Kidney Transplantation

BACKGROUND Cytomegalovirus (CMV) infection presents a significant challenge in transplant patients due to the limited arsenal of antiviral drugs and the potential for developing resistance. The treatment regimen typically involves the use of appropriate antivirals, routine CMV PCR monitoring, resistance testing, and managing associated drug toxicities. CASE REPORT Our case highlights the difficulties of managing CMV in transplant patients, particularly in the context of resistant strains. Key elements of the case include the development of significant and resistant viremia despite adequate prophylaxis, the strategic switch from ganciclovir to maribavir, and the persistent challenge of resistance. The subsequent introduction of foscarnet and the careful transition to letermovir after adequate viral suppression (<1000 UI/mL) were critical in maintaining it while minimizing drug toxicity. These strategic decisions ultimately led to a successful outcome for our patient, highlighting the importance of vigilant monitoring and timely therapeutic adjustments in preventing severe complications or even death. CONCLUSIONS In transplant patients, cytomegalovirus (CMV) infection, particularly when complicated by antiviral resistance, presents significant therapeutic challenges. A strategic approach, including the switch from ganciclovir to maribavir, foscarnet, and finally to letermovir, was critical in successfully managing the infection and preventing severe complications.