Ganciclovir and foscarnet dual-therapy for cytomegalovirus encephalitis: A case report and review of the literature

J Neurol Sci. 2018 May 15:388:28-36. doi: 10.1016/j.jns.2018.02.029. Epub 2018 Feb 20.

Abstract

Cytomegalovirus (CMV) is a ubiquitous herpesvirus which establishes lifelong latency following primary infection. It is then capable of reactivating in the face of immunosuppression. Encephalitis is a less common, but particularly devastating syndrome associated with CMV. Here, we describe a case of CMV encephalitis in an allogeneic hematopoietic stem cell transplant recipient who received dual antiviral therapy with ganciclovir and foscarnet. The case presentation is followed by a summary of cases reported in the last ten years, with the goal of describing vulnerable patient populations, treatment courses, and outcomes. Finally, the discussion includes a review of the literature, with a focus on diagnostic criteria and the role for dual antiviral therapy in CMV encephalitis.

Keywords: Cytomegalovirus; Encephalitis; Foscarnet; Ganciclovir; Immunosuppressed; Stem cell transplant.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Antiviral Agents / therapeutic use*
  • Cytomegalovirus Infections / complications
  • Cytomegalovirus Infections / diagnostic imaging
  • Cytomegalovirus Infections / drug therapy*
  • Cytomegalovirus Infections / immunology
  • Drug Therapy, Combination
  • Encephalitis, Viral / complications
  • Encephalitis, Viral / diagnostic imaging
  • Encephalitis, Viral / drug therapy*
  • Encephalitis, Viral / immunology
  • Female
  • Foscarnet / therapeutic use*
  • Ganciclovir / therapeutic use*
  • Graft vs Host Disease / complications
  • Graft vs Host Disease / immunology
  • Hematopoietic Stem Cell Transplantation
  • Humans
  • Immunocompromised Host
  • Middle Aged
  • Transplantation, Homologous

Substances

  • Antiviral Agents
  • Foscarnet
  • Ganciclovir