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CMV Disease — SCE Infectious Diseases MCQ

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HardImmunocompromised HostCMV DiseaseSCE Infectious Diseases

A 45-year-old renal transplant recipient on Tacrolimus, Mycophenolate, and Prednisolone presents 6 months post-transplant with fever, dry cough, and bilateral ground-glass opacities on CT chest. Bronchoalveolar lavage is positive for CMV by PCR (48,000 copies/mL) and negative for PJP. What is the most appropriate initial treatment?

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Correct answer: D — IV Ganciclovir 5 mg/kg BD, with dose adjustment for renal function

CMV pneumonitis in a solid organ transplant recipient with significant viral load requires IV Ganciclovir as first-line treatment (5 mg/kg BD adjusted for renal function). This is preferred over oral Valganciclovir for tissue-invasive CMV disease due to more reliable drug levels. Immunosuppression reduction should be considered as an adjunct. Foscarnet is reserved for Ganciclovir-resistant CMV or significant myelosuppression. The viral load and imaging are consistent with CMV disease rather than asymptomatic viraemia.

Reference: BHIVA 2019 – Management of CMV; NICE NG37 2016 – Solid organ transplant recipients: prevention of CMV disease