Cytomegalovirus (CMV) infection after lung transplantation is associated with increased risk for pneumonitis and bronchiolitis\nobliterans as well as allograft rejection and opportunistic infections. Ganciclovir is the mainstay of prophylaxis and treatment but\nCMV infections can be unresponsive. Apart from direct antiviral drugs, CMV immunoglobulin (CMVIG) preparations may be\nconsidered but are only licensed for prophylaxis. A CMV-seronegative 42-year-old man with cystic fibrosis received a lung from\na CMV-seropositive donor. Intravenous ganciclovir prophylaxis was delayed until day 12 due to acute postoperative renal failure\nand was accompanied by five doses of CMVIG (10 g). By day 16, CMV-DNA was detectable and rising; CMV-specific T-cells were\nundetectable. Switch from ganciclovir to foscarnet prompted a transient decrease in CMV viral load, but after increasing again to\nreach 3600 copies/mL foscarnet was changed to intravenous cidofovir and CMVIG was restarted. CMV load continued to fluctuate\nand declined slowly, whereas CMV-specific T-cells were detected five months later and increased thereafter. At last follow-up, the\npatient was in very good clinical condition with no evidence of bronchiolitis obliterans. No side effects of this treatment were\nobserved. In this hard-to-treat case, the combination of cidofovir with off-label use of CMVIG contributed to a successful outcome.
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