Brincidofovir Use after Foscarnet Crystal Nephropathy in a Kidney Transplant Recipient with Multiresistant Cytomegalovirus Infection
Background. Cytomegalovirus (CMV) antiviral drug resistance constitutes an increasing challenge in transplantation. Foscarnet is usually proposed when resistance for ganciclovir is suspected, but its use is limited by its nephrotoxicity. Case Presentation. We report a case of multiresistant CMV dise...
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| Format: | Article |
| Language: | English |
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Wiley
2017-01-01
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| Series: | Case Reports in Transplantation |
| Online Access: | http://dx.doi.org/10.1155/2017/3624146 |
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| author | Romain Vial Christine Zandotti Sophie Alain Alexandre Decourt Noémie Jourde-Chiche Raj Purgus Charleric Bornet Laurent Daniel Valérie Moal Tristan Legris |
| author_facet | Romain Vial Christine Zandotti Sophie Alain Alexandre Decourt Noémie Jourde-Chiche Raj Purgus Charleric Bornet Laurent Daniel Valérie Moal Tristan Legris |
| author_sort | Romain Vial |
| collection | DOAJ |
| description | Background. Cytomegalovirus (CMV) antiviral drug resistance constitutes an increasing challenge in transplantation. Foscarnet is usually proposed when resistance for ganciclovir is suspected, but its use is limited by its nephrotoxicity. Case Presentation. We report a case of multiresistant CMV disease in a kidney transplant recipient. Foscarnet was prescribed after ganciclovir treatment failure in a patient with two mutations in the UL97 viral gene. Foscarnet induced biopsy-proven kidney crystal precipitation that resulted in severe acute transplant failure and nephrotic syndrome. Despite a large decrease in immunosuppression, CMV disease was not controlled and a salvage therapy with Brincidofovir (BCV), which is an oral lipid conjugate of cidofovir with limited nephrotoxicity, was attempted. Clinical and virological remission was observed after a 21-day course of BCV, despite mild and reversible liver toxicity. However, a new relapse could not be effectively cured by BCV due to a new mutation in the UL54 gene, which is known to confer resistance to cidofovir. A new course of foscarnet finally resulted in prolonged CMV remission. Herein, we present a review of foscarnet nephropathy cases in solid-organ transplanted patients. Conclusions. This unique case highlights the potential benefit of BCV use during resistant CMV infection, although mutations in the UL54 gene may limit its therapeutic efficacy. These findings need to be confirmed in clinical trials. |
| format | Article |
| id | doaj-art-aee5f4f8d03c4c18973d32f9c8742eff |
| institution | Kabale University |
| issn | 2090-6943 2090-6951 |
| language | English |
| publishDate | 2017-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Transplantation |
| spelling | doaj-art-aee5f4f8d03c4c18973d32f9c8742eff2025-02-03T05:51:35ZengWileyCase Reports in Transplantation2090-69432090-69512017-01-01201710.1155/2017/36241463624146Brincidofovir Use after Foscarnet Crystal Nephropathy in a Kidney Transplant Recipient with Multiresistant Cytomegalovirus InfectionRomain Vial0Christine Zandotti1Sophie Alain2Alexandre Decourt3Noémie Jourde-Chiche4Raj Purgus5Charleric Bornet6Laurent Daniel7Valérie Moal8Tristan Legris9Centre de Néphrologie et Transplantation Rénale, Hôpital Conception, Assistance Publique-Hôpitaux de Marseille, Marseille, FranceFédération de Bactériologie-Virologie-Hygiène, Hôpital Timone, Assistance Publique-Hôpitaux de Marseille, Marseille, FranceLaboratoire de Bactériologie-Virologie-Hygiène, Centre Hospitalier Universitaire, Limoges, FranceCentre de Néphrologie et Transplantation Rénale, Hôpital Conception, Assistance Publique-Hôpitaux de Marseille, Marseille, FranceCentre de Néphrologie et Transplantation Rénale, Hôpital Conception, Assistance Publique-Hôpitaux de Marseille, Marseille, FranceCentre de Néphrologie et Transplantation Rénale, Hôpital Conception, Assistance Publique-Hôpitaux de Marseille, Marseille, FrancePharmacie Hospitalière, Hôpital Conception, Assistance Publique-Hôpitaux de Marseille, Marseille, FranceAix-Marseille University, Marseille, FranceCentre de Néphrologie et Transplantation Rénale, Hôpital Conception, Assistance Publique-Hôpitaux de Marseille, Marseille, FranceCentre de Néphrologie et Transplantation Rénale, Hôpital Conception, Assistance Publique-Hôpitaux de Marseille, Marseille, FranceBackground. Cytomegalovirus (CMV) antiviral drug resistance constitutes an increasing challenge in transplantation. Foscarnet is usually proposed when resistance for ganciclovir is suspected, but its use is limited by its nephrotoxicity. Case Presentation. We report a case of multiresistant CMV disease in a kidney transplant recipient. Foscarnet was prescribed after ganciclovir treatment failure in a patient with two mutations in the UL97 viral gene. Foscarnet induced biopsy-proven kidney crystal precipitation that resulted in severe acute transplant failure and nephrotic syndrome. Despite a large decrease in immunosuppression, CMV disease was not controlled and a salvage therapy with Brincidofovir (BCV), which is an oral lipid conjugate of cidofovir with limited nephrotoxicity, was attempted. Clinical and virological remission was observed after a 21-day course of BCV, despite mild and reversible liver toxicity. However, a new relapse could not be effectively cured by BCV due to a new mutation in the UL54 gene, which is known to confer resistance to cidofovir. A new course of foscarnet finally resulted in prolonged CMV remission. Herein, we present a review of foscarnet nephropathy cases in solid-organ transplanted patients. Conclusions. This unique case highlights the potential benefit of BCV use during resistant CMV infection, although mutations in the UL54 gene may limit its therapeutic efficacy. These findings need to be confirmed in clinical trials.http://dx.doi.org/10.1155/2017/3624146 |
| spellingShingle | Romain Vial Christine Zandotti Sophie Alain Alexandre Decourt Noémie Jourde-Chiche Raj Purgus Charleric Bornet Laurent Daniel Valérie Moal Tristan Legris Brincidofovir Use after Foscarnet Crystal Nephropathy in a Kidney Transplant Recipient with Multiresistant Cytomegalovirus Infection Case Reports in Transplantation |
| title | Brincidofovir Use after Foscarnet Crystal Nephropathy in a Kidney Transplant Recipient with Multiresistant Cytomegalovirus Infection |
| title_full | Brincidofovir Use after Foscarnet Crystal Nephropathy in a Kidney Transplant Recipient with Multiresistant Cytomegalovirus Infection |
| title_fullStr | Brincidofovir Use after Foscarnet Crystal Nephropathy in a Kidney Transplant Recipient with Multiresistant Cytomegalovirus Infection |
| title_full_unstemmed | Brincidofovir Use after Foscarnet Crystal Nephropathy in a Kidney Transplant Recipient with Multiresistant Cytomegalovirus Infection |
| title_short | Brincidofovir Use after Foscarnet Crystal Nephropathy in a Kidney Transplant Recipient with Multiresistant Cytomegalovirus Infection |
| title_sort | brincidofovir use after foscarnet crystal nephropathy in a kidney transplant recipient with multiresistant cytomegalovirus infection |
| url | http://dx.doi.org/10.1155/2017/3624146 |
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