valganciclovir and Hepatitis--Viral--Human

Primary infection by cytomegalovirus (CMV) commonly occurs subclinically or manifested by a self-limited mononucleosis-like syndrome in immunocompetent subjects. Severe clinical pictures are uncommon. We present a case of acute myopericarditis and hepatitis in a previously healthy 32-year-old man with primary CMV infection, assessed by serology and positive pp65 antigenemia. He was successfully treated with a course of oral valganciclovir therapy, with an immediate clinical response and normalization of laboratory tests. The literature on simultaneous presentation of CMV pericarditis and hepatitis in immunocompetent hosts, as well as the role of oral valganciclovir in this clinical setting, is reviewed.

Topics: Administration, Oral; Adult; Cytomegalovirus; Cytomegalovirus Infections; Ganciclovir; Hepatitis, Viral, Human; Humans; Immunocompetence; Male; Myocarditis; Pericarditis; Treatment Outcome; Valganciclovir

BACKGROUND Cytomegalovirus (CMV) is a member of Herpesviridae family with its name derived from the fact that it causes enlargement of the infected cell resulting in the characteristic inclusion bodies seen on microscopy. CMV virus has an incubation period of about 4 to 6 weeks. Symptoms of CMV infection vary and depend on factors including the age and immune status of the patient. It usually presents as asymptomatic infection in immunocompetent individuals whereas severe disease is usually seen in immunocompromised patients. Here we present a case of an immunocompetent patient who presented with acute CMV hepatitis. CASE REPORT A 35-year-old male with no significant prior medical history who presented to the Emergency Department with a 2-week history of low-grade fever. Acute CMV infection was diagnosed by positive CMV antibody and polymerase chain reaction (PCR) testing. The patient was treated with valganciclovir that resulted in rapid improvement in clinical status as well as normalization of the liver enzymes. CONCLUSIONS This article presents a rare case of immunocompetent young male with acute CMV hepatitis who responded favorably to antiviral therapy.

Topics: Adult; Antiviral Agents; Cytomegalovirus Infections; Hepatitis, Viral, Human; Humans; Immunocompetence; Male; Valganciclovir

Described is the case of a 21-year-old male patient who presented with a severe Epstein-Barr virus (EBV) hepatitis. The initial diagnosis was challenging, as the patient did not have the typical features of the mononucleosis syndrome and despite the severity of the hepatitis, the initial serology was negative. In addition the liver biopsy did not show the mononuclear cell infiltration typically seen in EBV hepatitis. Later, measurements of EBV DNA showed high titers and the patient received a course of oral valganciclovir, following which he made a rapid clinical and serological response. This case describes an unusual presentation of EBV hepatitis, and adds to the body of evidence supporting its treatment with valganciclovir.

Topics: Antiviral Agents; DNA, Viral; Epstein-Barr Virus Infections; Ganciclovir; Hepatitis, Viral, Human; Humans; Male; Treatment Outcome; Valganciclovir; Young Adult

We describe the case of an 18-year-old immunocompetent male patient with severe hepatitis during primary Epstein-Barr virus infection, treated with oral valganciclovir. During the initial therapy with corticosteroids, the patient's clinical condition and liver function worsened, so we decided to add oral valganciclovir for its good bio-availability and previous encouraging experiences in different clinical settings, with rapid resolution of the symptoms.

Topics: Adolescent; Antiviral Agents; Epstein-Barr Virus Infections; Ganciclovir; Hepatitis, Viral, Human; Humans; Male; Treatment Outcome; Valganciclovir

Topics: Adult; Female; Ganciclovir; Hepatitis, Viral, Human; Herpes Simplex; Humans; Liver Failure, Acute; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Trimester, Third; Valganciclovir

Cytomegalovirus infection is usually asymptomatic or resembles infectious mononucleosis with fever, pharyngitis, arthralgias, lymphadenopathy, and atypical lymphocytosis. Even though primary CMV infection is usually self-limited in healthy individuals, significant complications can develop in immunocompromised patients. Venous or arterial thromboembolic phenomena are uncommon, yet very serious complications of CMV infection. Most published reports describe immunosupressed patients after organ transplantation or in the presence of HIV co-infection. However, thrombotic events in CMV infected immunocompetent individuals may occur. We describe the case of an immunocompetent adolescent with acute cytomegalovirus hepatitis that was complicated with pulmonary embolism and portal vein thrombosis. To our knowledge, this is the first reported case in which these two thrombotic phenomena occurred simultaneously in an adolescent with no obvious predisposing factors for thrombosis in the setting of an acute CMV infection.

Topics: Acute Disease; Adolescent; Cytomegalovirus Infections; Female; Ganciclovir; Hepatitis, Viral, Human; Humans; Immunocompetence; Portal Vein; Pulmonary Embolism; Valganciclovir; Venous Thrombosis

Topics: Antiviral Agents; Cytomegalovirus Infections; Ganciclovir; Hepatitis, Viral, Human; Humans; Infant, Newborn; Infant, Premature, Diseases; Male; Valganciclovir

Cytomegalovirus (CMV) infection after solid organ transplantation is one of the most common viral infections, causing significant morbidity and mortality if not treated promptly. Ganciclovir has proven to be effective for the prophylaxis and treatment of CMV. However, oral absorption of ganciclovir is poor. Recently, oral administration of valganciclovir hydrochloride (Valcyte) has been observed to display 10-fold better absorption than oral ganciclovir. Valganciclovir has increasingly been used as prophylaxis against CMV after solid organ transplantation. The purpose of this study was to examine the efficacy of valganciclovir prophylaxis therapy after primary liver transplantation.. Between July 2001 and May 2003, 203 consecutive liver transplant recipients, including 129 men and 74 women of overall mean age 53 +/- 11 years, received valganciclovir (900 mg/d or 450 mg every other day depending on renal function) for 3 to 6 months after primary liver transplantation. All patients were followed up for a minimum of 6 months. Mean follow-up was 19 +/- 5.8 months. CMV DNA in peripheral blood was tested using polymerase chain reaction (PCR) amplification. Symptomatic CMV was stratified according to the CMV immunoglobulin (Ig)G status of the donor and recipient at the time of liver transplantation. Donors and recipients were classified preoperatively into groups according to the presence or absence of CMV as follows: group 1 (n = 73; donor CMV+, recipient CMV+); group 2 (n = 41; donor CMV-, recipient CMV+); group 3 (n = 54; donor CMV+, recipient CMV-; high-risk group); and group 4 (n = 35; donor CMV-, recipient CMV-).. Twenty-nine patients (14.3%) developed symptomatic CMV disease at 169 +/- 117 days after liver transplantation: group 1, 16.4% versus group 2, 7.3% versus group 3, 25.9% versus group 4, 0%. Of these patients, 5 also had invasive CMV on liver biopsy, which was performed owing to abnormal liver functions. All 29 patients were treated with intravenous ganciclovir. One patient died owing to disseminated CMV, whereas the remaining 28 patients responded to treatment. Interestingly, 8 patients, including 1 who had invasive CMV hepatitis, developed symptomatic CMV within 90 days of liver transplantation even while on prophylactic valganciclovir.. Valganciclovir failed to provide adequate prophylaxis following liver transplantation in our patients. The overall rate of CMV in seropositive donors and/or recipients was 17%, and in the high-risk group was 26%. Further prospective studies with measurement of ganciclovir concentrations are needed to elucidate the reasons for this unexpected failure.

Topics: Adult; Antibodies, Viral; Antiviral Agents; Biopsy; Cytomegalovirus; Cytomegalovirus Infections; DNA, Viral; Female; Ganciclovir; Hepatitis, Viral, Human; Humans; Immunoglobulin G; Liver Transplantation; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Valganciclovir