Case Report: Management of a Multidrug-Resistant CMV-Strain in a Renal Transplant Recipient by High-Dose CMV-Specific Immunoglobulins, Modulation in Immunosuppression, and Induction of CMV-Specific Cellular Immunity

The management of multidrug-resistant strains of cytomegalovirus after solid organ transplantation is challenging. This case report demonstrates the successful treatment of a multidrug-resistant strain of cytomegalovirus that may represent a valuable option for problematic cases. This report illustr...

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Autores principales: Wiening, Vanessa, Schmidt, Tina, Dahmen, Maximilian, Siam, Sami, Reuter, Stefan, Pavenstädt, Hermann-Joseph, Sester, Martina, Suwelack, Barbara
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7868410/
https://www.ncbi.nlm.nih.gov/pubmed/33569064
http://dx.doi.org/10.3389/fimmu.2020.623178
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author Wiening, Vanessa
Schmidt, Tina
Dahmen, Maximilian
Siam, Sami
Reuter, Stefan
Pavenstädt, Hermann-Joseph
Sester, Martina
Suwelack, Barbara
author_facet Wiening, Vanessa
Schmidt, Tina
Dahmen, Maximilian
Siam, Sami
Reuter, Stefan
Pavenstädt, Hermann-Joseph
Sester, Martina
Suwelack, Barbara
author_sort Wiening, Vanessa
collection PubMed
description The management of multidrug-resistant strains of cytomegalovirus after solid organ transplantation is challenging. This case report demonstrates the successful treatment of a multidrug-resistant strain of cytomegalovirus that may represent a valuable option for problematic cases. This report illustrates the emergence of a multidrug-resistant cytomegalovirus (CMV) UL54 mutant strain in a renal transplant recipient with severe lymphopenia and thrombocytopenia. We show that the combined treatment with high-dose intravenous cytomegalovirus-specific immunoglobulins (CMV-IVIG) after the switch to a mammalian target of rapamycin (mTOR)-inhibitor and cyclosporine A was a successful treatment alternative to direct antiviral treatment with high-dose ganciclovir and foscarnet. This treatment was associated with a quantitative induction of CMV-specific CD4 and CD8 T cells that showed maturation in phenotype and functionality with decreasing viral load. Our case report illustrates that high-dose CMV-IVIG and conversion of immunosuppressive drugs to mTOR inhibitors and cyclosporine A can be a successful treatment in a situation where the use of direct antiviral drugs was considered insufficient.
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spelling pubmed-78684102021-02-09 Case Report: Management of a Multidrug-Resistant CMV-Strain in a Renal Transplant Recipient by High-Dose CMV-Specific Immunoglobulins, Modulation in Immunosuppression, and Induction of CMV-Specific Cellular Immunity Wiening, Vanessa Schmidt, Tina Dahmen, Maximilian Siam, Sami Reuter, Stefan Pavenstädt, Hermann-Joseph Sester, Martina Suwelack, Barbara Front Immunol Immunology The management of multidrug-resistant strains of cytomegalovirus after solid organ transplantation is challenging. This case report demonstrates the successful treatment of a multidrug-resistant strain of cytomegalovirus that may represent a valuable option for problematic cases. This report illustrates the emergence of a multidrug-resistant cytomegalovirus (CMV) UL54 mutant strain in a renal transplant recipient with severe lymphopenia and thrombocytopenia. We show that the combined treatment with high-dose intravenous cytomegalovirus-specific immunoglobulins (CMV-IVIG) after the switch to a mammalian target of rapamycin (mTOR)-inhibitor and cyclosporine A was a successful treatment alternative to direct antiviral treatment with high-dose ganciclovir and foscarnet. This treatment was associated with a quantitative induction of CMV-specific CD4 and CD8 T cells that showed maturation in phenotype and functionality with decreasing viral load. Our case report illustrates that high-dose CMV-IVIG and conversion of immunosuppressive drugs to mTOR inhibitors and cyclosporine A can be a successful treatment in a situation where the use of direct antiviral drugs was considered insufficient. Frontiers Media S.A. 2021-01-25 /pmc/articles/PMC7868410/ /pubmed/33569064 http://dx.doi.org/10.3389/fimmu.2020.623178 Text en Copyright © 2021 Wiening, Schmidt, Dahmen, Siam, Reuter, Pavenstädt, Sester and Suwelack http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Immunology
Wiening, Vanessa
Schmidt, Tina
Dahmen, Maximilian
Siam, Sami
Reuter, Stefan
Pavenstädt, Hermann-Joseph
Sester, Martina
Suwelack, Barbara
Case Report: Management of a Multidrug-Resistant CMV-Strain in a Renal Transplant Recipient by High-Dose CMV-Specific Immunoglobulins, Modulation in Immunosuppression, and Induction of CMV-Specific Cellular Immunity
title Case Report: Management of a Multidrug-Resistant CMV-Strain in a Renal Transplant Recipient by High-Dose CMV-Specific Immunoglobulins, Modulation in Immunosuppression, and Induction of CMV-Specific Cellular Immunity
title_full Case Report: Management of a Multidrug-Resistant CMV-Strain in a Renal Transplant Recipient by High-Dose CMV-Specific Immunoglobulins, Modulation in Immunosuppression, and Induction of CMV-Specific Cellular Immunity
title_fullStr Case Report: Management of a Multidrug-Resistant CMV-Strain in a Renal Transplant Recipient by High-Dose CMV-Specific Immunoglobulins, Modulation in Immunosuppression, and Induction of CMV-Specific Cellular Immunity
title_full_unstemmed Case Report: Management of a Multidrug-Resistant CMV-Strain in a Renal Transplant Recipient by High-Dose CMV-Specific Immunoglobulins, Modulation in Immunosuppression, and Induction of CMV-Specific Cellular Immunity
title_short Case Report: Management of a Multidrug-Resistant CMV-Strain in a Renal Transplant Recipient by High-Dose CMV-Specific Immunoglobulins, Modulation in Immunosuppression, and Induction of CMV-Specific Cellular Immunity
title_sort case report: management of a multidrug-resistant cmv-strain in a renal transplant recipient by high-dose cmv-specific immunoglobulins, modulation in immunosuppression, and induction of cmv-specific cellular immunity
topic Immunology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7868410/
https://www.ncbi.nlm.nih.gov/pubmed/33569064
http://dx.doi.org/10.3389/fimmu.2020.623178
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