Ann Clin Microbiol.  2015 Jun;18(2):64-67. 10.5145/ACM.2015.18.2.64.

The First Case of Ganciclovir-Resistant Cytomegalovirus Colitis with a 597-600 Deletion in UL97 Gene after Stem Cell Transplantation in Korea

• Seol CA
• Ko YJ
• Kim SH
• Kim MN
• Sung H
• Lee JH

• KMID: 1971115
• DOI: http://doi.org/10.5145/ACM.2015.18.2.64

Abstract

Human cytomegalovirus (CMV) infection has been a major concern in hematopoietic stem cell transplant recipients. Ganciclovir (GCV) resistance results mostly from mutations within the protein kinase UL97 gene. The three hot spots for GCV resistance (codons 460, 520, and 590-607) were well known. We describe a case of GCV-resistant CMV colitis caused by a 597-600 deletion in UL97 after haplo-identical peripheral blood stem cell transplantation (h-PBSCT) in a 46 year-old man with myelodysplastic syndrome. On post-PBSCT day 28, CMV antigenemia turned positive. Treatment of GCV was started and continued for 12 weeks but CMV antigenemia did not respond to the treatment and CMV colitis was worsened. The UL97 showed the in-frame deletion between codons 597 and 600 by direct sequencing. The treatment was switched to foscarnet and the antigenemia test was consecutively negative twice, and clinical symptoms improved. Despite the recovery of the patient from CMV colitis, the patient expired post-PBSCT day 146 from acute liver failure, hepatorenal syndrome and septic shock. This case is a first report of a deletion 597-600 in CMV UL97 in Korea. A 597-600 deletion in UL97 was responsible for the GCV resistance while preserving susceptibility to foscarnet.

Keyword

Cytomegalovirus; Drug resistance; Ganciclovir; UL97

MeSH Terms

Codon
Colitis*
Cytomegalovirus*
Drug Resistance
Foscarnet
Ganciclovir
Hematopoietic Stem Cells
Hepatorenal Syndrome
Humans
Korea
Liver Failure, Acute
Myelodysplastic Syndromes
Peripheral Blood Stem Cell Transplantation
Protein Kinases
Shock, Septic
Stem Cell Transplantation*
Transplantation
Codon
Foscarnet
Ganciclovir
Protein Kinases

Figure

• 

  Fig. 1. Serial follow-up of cytomegalovirus (CMV) pp65 antigenemia. The duration of antiviral drug administration is illustrated by the bar graph at the top of the figure. Abbreviations: GCV, ganciclovir; FOS, foscarnet.

• 

  Fig. 2. Codons 597-600 deletion and the D605E polymorphism in human cytomegalovirus UL97. *D605E polymorphism.

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