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CMV Disease — SCE Infectious Diseases MCQ

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ModerateImmunocompromised HostCMV DiseaseSCE Infectious Diseases

A 40-year-old woman with a recent liver transplant develops diarrhoea, viraemia, and colonic ulceration on sigmoidoscopy with CMV immunohistochemistry-positive biopsy. She is on Valganciclovir prophylaxis 900 mg daily. CMV viral load is rising. What is the most likely explanation?

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Correct answer: C — Breakthrough CMV disease due to inadequate prophylactic dosing for tissue-invasive disease; switch to IV Ganciclovir at treatment dose

Valganciclovir 900 mg daily is a prophylactic dose. Tissue-invasive CMV disease (colitis) with rising viraemia on prophylactic dosing requires escalation to full treatment dose: IV Ganciclovir 5 mg/kg BD (adjusted for renal function). Resistance testing (UL97 and UL54 gene sequencing) should be sent if viraemia persists despite adequate treatment dosing. Reduction of immunosuppression (particularly Mycophenolate) should also be considered.

Reference: NICE NG37 2016 – Solid organ transplant: CMV; BHIVA 2019 – CMV management