Disseminated Ganciclovir-Resistant Cytomegalovirus in a Nontransplant Pediatric ALL Patient: A Case Report.
Marielys Collazo-Roman, Jodi O'Connor, William S Wilson et al.
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Case in brief
An 8-year-old patient with T-ALL on maintenance chemotherapy developed significant CMV viremia without initial end-organ disease, which progressed to ganciclovir-resistant CMV infection. Despite treatment with valganciclovir, foscarnet, and maribavir, the patient experienced complications, including CMV retinitis. This case highlights the challenges in managing CMV in nontransplant pediatric patients with prolonged lymphopenia.
What made this case unusual
The emergence of ganciclovir-resistant CMV in a nontransplant pediatric patient with ALL is a rare occurrence, particularly in the absence of initial end-organ disease.
Diagnostic / clinical pearl
Clinicians should be aware of the risk of ganciclovir-resistant CMV infection in pediatric ALL patients, especially those with prolonged lymphopenia.
Why it matters
This case emphasizes the need for enhanced CMV surveillance and resistance-guided treatment strategies in high-risk pediatric populations.