Valcyte (valganciclovir) / Roche, Tanabe Pharma - LARVOL DELTA

Replication-Competent Adenoviral Double-Suicide Therapy with fSRS in Progressive Glioblastoma (RAD-Gli): A Phase 1 Trial (ASTRO 2026) - "Patients received prodrug therapy consisting of 4 days of 5-fluorocytosine (150 mg/kg/day, orally) and valganciclovir (1800 mg/daily) for 13 days... MTD was reached at dose level 2, 1x1011. Median overall survival is promising at 12.3 months."

P1 data • Brain Cancer • Glioblastoma • Oncology • Solid Tumor

Cytomegalovirus Gastritis Presenting as a Gastric Mass in an Immunocompetent Elderly Patient (ACG 2026) - "He was started on valganciclovir for CMV gastritis and is pending repeat endoscopic evaluation...When clinical suspicion persists despite nondiagnostic pathology, repeat endoscopy with additional tissue sampling may be critical for diagnosis. Figure: Figure 1: Initial endoscopy with gastric ulcers involving the cardia, incisura, and pylorus Figure: Figure 2: Surveillance endoscopy with 3 cm protruding antral mass concerning for malignancy"

Clinical • Cardiovascular • Cognitive Disorders • Cytomegalovirus Infection • Diabetes • Gastroenterology • Gastrointestinal Disorder • Hypertension • Immunology • Infectious Disease • Inflammatory Bowel Disease • Metabolic Disorders • Peptic Ulcer • Type 2 Diabetes Mellitus • Ulcerative Colitis

Unmasked by Steroids: CMV Colitis Mimicking IEC-Enterocolitis After CAR-T Therapy (ACG 2026) - "Case Description/ A 48-year-old male with relapsed/refractory diffuse large B-cell lymphoma received CAR-T therapy (axicabtagene ciloleucel)...11 weeks post-infusion, he presented with sepsis requiring stress-dose hydrocortisone...Due to the high mortality of IEC-EC, IV steroids were started until CMV immunostaining returned with numerous inclusions and CMV PCR from HD2 resulted at 316,000 IU/mL (HD 11); valganciclovir was initiated...Standard valacyclovir prophylaxis has no CMV activity yet may create false reassurance...(A) H&E stain showing crypt dropout, apoptotic bodies - features that overlap with both CMV colitis and IEC-EC, and were initially interpreted as a GVHD/IEC-EC pattern of injury. (B) CMV immunohistochemical stain with numerous positive cells (brown) confirming the diagnosis of CMV colitis."

CAR T-Cell Therapy • B Cell Lymphoma • Cytomegalovirus Infection • Diffuse Large B Cell Lymphoma • Gastroenterology • Gastrointestinal Disorder • Graft versus Host Disease • Hematological Malignancies • Immunology • Infectious Disease • Lymphoma • Non-Hodgkin’s Lymphoma • Septic Shock

Beyond the Obstruction: Cytomegalovirus Duodenitis as a Herold for Diffuse Large B-Cell Lymphoma (ACG 2026) - "His symptoms improved with pantoprazole...He was treated with 21 days of valganciclovir, resulting in partial improvement of symptoms and ability to tolerate a regular diet...Figure: Figure 2. Coronal CT image showing a stricture near the duodenojejunal junction with upstream dilatation of the duodenum and stomach concerning for small bowel obstruction."

B Cell Lymphoma • Cytomegalovirus Infection • Diffuse Large B Cell Lymphoma • Epstein-Barr Virus Infections • Gastroenterology • Gastrointestinal Disorder • Hematological Malignancies • Hepatitis B • Hepatology • Human Immunodeficiency Virus • Immunology • Infectious Disease • Lymphoma • Non-Hodgkin’s Lymphoma

Silent Cytomegalovirus Esophagitis in a Patient With Waldenström's Macroglobulinemia on Ibrutinib Followed by Esophagitis Dissecans Superficialis (ACG 2026) - "Oncology was notified, and valganciclovir 900 mg twice daily was prescribed for 14 days. EDS may reflect epithelial fragility, healing after viral esophagitis, reflux injury, medication effect, or local trauma. Figure: CMV Esophagitis Figure: Esophagitis Dissecans Superficialis"

Clinical • Cardiovascular • Cytomegalovirus Infection • Gastroesophageal Reflux Disease • Gastrointestinal Disorder • Hematological Disorders • Infectious Disease • Lymphoma • Lymphoplasmacytic Lymphoma • Waldenstrom Macroglobulinemia

A Rare Diagnosis From a Positive FIT: CMV Colonic Pseudotumor in an Immunocompetent Patient (ACG 2026) - "Currently he is undergoing treatment with oral valganciclovir for a 21-day course with a plan to repeat colonoscopy in 3 months to confirm resolution...B, inset. CMV immunohistochemistry highlights multiple viral inclusions in a single high-power field."

Clinical • Bladder Cancer • Colon Cancer • Colorectal Cancer • Cytomegalovirus Infection • Diabetes • Dyslipidemia • Gastric Cancer • Gastroenterology • Gastrointestinal Disorder • Genetic Disorders • Genito-urinary Cancer • Human Immunodeficiency Virus • Hypertension • Immunology • Infectious Disease • Metabolic Disorders • Obesity • Oncology • Solid Organ Transplantation • Solid Tumor

A Rare Case of Carbidopa-Levodopa Induced Colitis Complicated by Cytomegalovirus (ACG 2026) - "She was started on budesonide and mesalamine and had gradual improvement of diarrhea with resolution of hematochezia...She was treated with valganciclovir...(B) Random colon biopsies two months following carbidopa-levodopa discontinuation had crypt architectural distortion and focal mild inflammation, consistent with mucosal healing. H&E stained sections, 100x magnifications."

Clinical • CNS Disorders • Constipation • Cytomegalovirus Infection • Gastroenterology • Gastrointestinal Disorder • Immunology • Inflammation • Inflammatory Bowel Disease • Movement Disorders • Parkinson's Disease • Ulcerative Colitis • CRP

A Diagnostic Enigma: Concurrent Infectious and Neoplastic Colitis Presenting in a Patient With Advanced AIDS (ACG 2026) - "Treatment consisted of Valganciclovir for CMV colitis, and antibiotics for disseminated MAC prior to HAART initiation to mitigate Mycobacterium Avium Complex Immune Reconstitution Syndrome (MAC-IRIS). The patient ultimately began Doxorubicin in the treatment of visceral KS, with repeat colonoscopy to assess for disease response...Figure: Figure A: Violaceous lesions visualized at the rectum and rectosigmoid junction, consistent with Kaposi Sarcoma; Figure B: Violaceous and ulcerating lesions visualized at the sigmoid colon Figure: Figure A: AFB stain (800X) highlights numerous intracytoplasmic acid-fast bacilli; Figure B: HHV8 immunostaining (400X): Multiple nuclei are positive for HHV8;Figure C: H&E (400X): Acutely inflamed granulation tissue. A cell with owl's eye intranuclear CMV viral inclusion (arrow)"

Clinical • Metastases • Cytomegalovirus Infection • Epstein-Barr Virus Infections • Gastroenterology • Gastrointestinal Disorder • Human Immunodeficiency Virus • Immunology • Infectious Disease • Kaposi Sarcoma • Respiratory Diseases • Sarcoma • Solid Tumor • CD4

The Biopsy Was Negative... Until It Wasn't: CMV Duodenitis Presenting With Melena (ACG 2026) - "He was treated with high dose steroids and required infliximab as well at that time.?This admission, CTA of the abdomen and pelvis revealed duodenitis, but no evidence of arterial extravasation...The patient was treated with valganciclovir and is currently being followed up with infectious diseases to determine the duration of therapy...Figure: Figure 1. Forrest III ulcer noted in the duodenal bulb (1A,B,C)."

Biopsy • Cytomegalovirus Infection • Gallbladder Cancer • Gastroenterology • Gastrointestinal Disorder • Immunology • Infectious Disease • Peptic Ulcer • Solid Tumor

Could Less Be More? Reconsidering Immunosuppressive Escalation in Refractory Immune Effector Cell-Associated Enterocolitis Complicated by Recurrent C. difficile Infection (ACG 2026) - "Case Description/ A 73-year-old male with multiple myeloma (MM) refractory to several lines of therapy underwent CAR-T infusion with ciltacabtagene autoleucel, developing biopsy-proven disease progression with infiltrative extramedullary disease of the GI tract...difficile PCR returned positive with negative toxin, creating diagnostic uncertainty in the setting of suspected IEC-AE; fidaxomicin was initiated...Diarrhea worsened despite two doses each of cyclophosphamide and vedolizumab...Concurrently, vancomycin was initiated for repeat C. difficile infection and valganciclovir for cytomegalovirus viremia. Ruxolitinib was given for refractory IEC-AE alongside fludarabine for the recurrent and progressive MM involving the GI tract...(A) Upper endoscopy demonstrating diffuse nodular mucosa involving the duodenal bulb and 1st and 2nd portions of the duodenum. (B) Colonoscopy showing grossly normal ascending, transverse, and descending colon despite biopsy-confirmed IEC-AE."

Cytomegalovirus Infection • Gastroenterology • Gastrointestinal Disorder • Hematological Malignancies • Immunology • Infectious Disease • Inflammatory Bowel Disease • Multiple Myeloma

CMV Esophagitis in the Setting of Nivolumab and Ipilimumab Therapy (ACG 2026) - "The patient was given dexamethasone and discharged home with endoscopy scheduled for two days later...Plasma CMV level drawn prior to ganciclovir initiation was found to be 4290 IU/mL. The patient had subsequent improvement of his dysphagia and odynophagia and was discharged after PEG tube placement on oral valganciclovir therapy...(C): Lower third of the esophagus; LA grade D esophagitis. (D): Gastric fundus."

CNS Disorders • Cytomegalovirus Infection • Gastrointestinal Disorder • Infectious Disease • Melanoma • Movement Disorders • Parkinson's Disease • Solid Tumor

Cytomegalovirus Colitis Unmasking Previously Undiagnosed Common Variable Immunodeficiency and Classic Hodgkin Lymphoma (ACG 2026) - "He was started on valganciclovir and chemotherapy with nivolumab. His course was further complicated by Campylobacter infection treated with azithromycin...In this case, CMV colitis initially appeared to explain the patient's gastrointestinal symptoms; however, persistent constitutional symptoms, profound hypogammaglobulinemia, and mediastinal lymphadenopathy prompted further evaluation that ultimately revealed cHL. This case underscores that CMV colitis in a young adult without an apparent cause of immunosuppression should prompt comprehensive evaluation for occult immunodeficiency and hematologic malignancy, as early tissue diagnosis is critical to avoid delays in definitive treatment and improve clinical outcomes."

Classical Hodgkin Lymphoma • Cytomegalovirus Infection • Gastroenterology • Gastrointestinal Disorder • Hematological Malignancies • Hodgkin Lymphoma • Immunology • Infectious Disease • Lymphoma • Primary Immunodeficiency

When CMV Breaks the Rules: Severe Cytomegalovirus Colitis Masquerading as Inflammatory Bowel Disease in an Immunocompetent Host (ACG 2026) - "The patient was treated with valganciclovir, resulting in clinical improvement and stabilization of hemoglobin levels...Early recognition can facilitate appropriate antiviral therapy, prevent unnecessary immunosuppression, and improve clinical outcomes. Figure: CMV Immunohistochemistry and Endoscopic findings"

Colorectal Cancer • Crohn's disease • Cytomegalovirus Infection • Gastroenterology • Gastrointestinal Disorder • Hematological Disorders • Human Immunodeficiency Virus • Immunology • Infectious Disease • Inflammation • Inflammatory Bowel Disease • Mucositis • Ulcerative Colitis

Medically Refractory Acute Severe Ulcerative Colitis Complicated by Cytomegalovirus Managed With Diverting Loop Ileostomy During Pregnancy: A Case Report (ACG 2026) - "Case Description/ A 23-year-old woman with a 10-year history of ulcerative pancolitis being treated with upadacitinib 45mg and prednisone 40mg was transferred from another hospital at 25 weeks gestation with 2 weeks of bloody diarrhea. She had loss of response or non-response to adalimumab, vedolizumab, ustekinumab, and prior response to infliximab induction but lost response after switching to subcutaneous maintenance...Intravenous solumedrol was started on day 1 and upadacitinib was continued...She continued infliximab and valganciclovir and tapered off prednisone outpatient...Secondly, the management of CMV colitis during pregnancy may differ from non-pregnant individuals, as ganciclovir is typically avoided due to potential risks to the fetus...Figure: Figure 1: Representative image from flexible sigmoidoscopy showing severe colitis with erythema and ulcerations. Figure: Figure 2: Picture of the patientâs ostomy wound two weeks post-op."

Case report • Clinical • Cytomegalovirus Infection • Gastroenterology • Gastrointestinal Disorder • Immunology • Inflammatory Bowel Disease • Ulcerative Colitis • CRP

Small Bowel Crohnâs Presenting as CMV Ileitis in an Immunocompetent Patient (ACG 2026) - "He was diagnosed with CMV ileitis and treated with valganciclovir 450 mg twice daily for five weeks with significant improvement...He was diagnosed with ileocecal Crohn's disease and started on budesonide followed by adalimumab with significant improvement at 3-month follow up...Figure: FIGURE 1 - Hematoxylin and eosin staining from terminal ileum biopsy demonstrating CMV cytopathic inclusions in a background of chronic active enteritis. Figure: FIGURE 2 - Repeat terminal ileum biopsy demonstrating chronic active ileitis with ulceration and negative CMV immunostaining."

Clinical • Crohn's disease • Cytomegalovirus Infection • Gastroenterology • Gastrointestinal Disorder • Human Immunodeficiency Virus • Immunology • Infectious Disease • Inflammation • Inflammatory Bowel Disease • CRP

Hickamâs Dictum: Disseminated Histoplasmosis and CMV Masquerading as an Ileocecal Mass (ACG 2026) - "Empirical treatment with budesonide yielded no improvement...The patient was initiated on liposomal amphotericin B, and valganciclovir was added for treatment of CMV colitis due to persistent fevers...(B) Grocottâs methenamine silver (GMS) staining highlights numerous oval yeasts with occasional narrow-based budding, morphologically consistent with Histoplasma capsulatum. (C) CMV immunohistochemical staining demonstrates a positive cell within the granulation tissue."

Anorexia • Cytomegalovirus Infection • Gastroenterology • Gastrointestinal Disorder • Human Immunodeficiency Virus • Immunology • Infectious Disease

Herpes Simplex Virus Hepatitis Presenting as Acute Liver Failure: A Diagnostic Challenge (ACG 2026) - "Case Description/ We present a case of a 60 year-old female with a history of alcohol use disorder, Hashimotoâs thyroiditis, and unspecified autoimmune disease on hydroxychloroquine who presented to an outside hospital with right upper quadrant pain and predominantly hepatocellular liver injury...She was intubated and started on empiric IV Valganciclovir and N-acetylcysteine prior to transferring to a liver transplant center...HSV hepatitis is often fatal if left untreated, and treatment with empiric IV acyclovir should be initiated promptly because of its favorable safety profile and potential survival benefit...HE 60x stain depicts viral inclusions with associated necrosis. HSV 1 and 2 IHC 60x of the liver confirms the diagnosis of HSV hepatitis."

Addiction (Opioid and Alcohol) • Autoimmune Hepatitis • Cardiovascular • CNS Disorders • Endocrine Disorders • Hepatitis C • Hepatology • Herpes Simplex • Immunology • Infectious Disease • Inflammation • Liver Failure

Successful Liver Transplantation in a Monolung Patient With Alcohol-Associated Cirrhosis and Prior Pulmonary Carcinoid Tumor (ACG 2026) - "Postoperative complications included acute renal failure requiring CVVH and CMV reactivation treated with valganciclovir...Careful multidisciplinary evaluation, physiologic assessment, and perioperative planning allowed successful transplantation and maintenance despite traditionally high-risk features. Thus, prior pneumonectomy alone should not be considered an absolute contraindication to liver transplantation in appropriately selected patients."

Clinical • Acute Kidney Injury • Addiction (Opioid and Alcohol) • Carcinoid Tumor • CNS Disorders • Fibrosis • Gastroenterology • Hepatic Encephalopathy • Hepatology • Immunology • Lung Cancer • Oncology • Solid Tumor • Transplantation

West Nile Virus Neuroinvasive Disease in a Transplant Recipient: A Diagnostic Challenge (ACG 2026) - "Case Description/ A 64-year-old white male undergoes liver transplantation due to left portal vein thrombosis and presumed alcohol-related liver cirrhosis and is placed on tacrolimus and mycophenolate mofetil...Repeat testing reveals CMV viremia, and treatment-dose valganciclovir is initiated; however, fever and progressive encephalopathy persist. Further history reveals recent exposure to mosquitoes and ticks, prompting arboviral testing and empiric doxycycline...Ultimately, a history of mosquito exposure prompted CSF WNV IgM testing, confirming the diagnosis. Early targeted testing in similar presentations may prevent unnecessary treatment and facilitate appropriate management."

Clinical • Cardiovascular • CNS Disorders • Cytomegalovirus Infection • Fibrosis • Gastroenterology • Hematological Disorders • Hepatology • Hypotension • Immunology • Infectious Disease • Liver Cirrhosis • Movement Disorders • Musculoskeletal Pain • Novel Coronavirus Disease • Solid Organ Transplantation • Thrombosis • Transplantation

Triple Trouble in the Duodenum: Duodenitis Caused by Histoplasma, Cytomegalovirus, and Helicobacter pylori in an Immunocompromised Host (ACG 2026) - "Immunosuppression included mycophenolate and prednisone, with valganciclovir for CMV suppression...The patient was treated with amphotericin B induction followed by posaconazole for disseminated histoplasmosis, continued valganciclovir for CMV, and completed fluoroquinolone-based H. pylori therapy with pantoprazole, amoxicillin, and levofloxacin...Figure: EGD showing 20 x 10 mm duodenal Forrest Class III ulcer. Figure: PAS stain of duodenal biopsy, showing histoplasmosis within macrophages."

Chronic Kidney Disease • Cytomegalovirus Infection • Gastroenterology • Gastrointestinal Disorder • Glomerulonephritis • Hematological Disorders • Immunology • Infectious Disease • Inflammatory Arthritis • Lupus • Lupus Nephritis • Nephrology • Peptic Ulcer • Renal Disease • Solid Organ Transplantation

Overlapping Etiologies of Colitis in an Immunosuppressed Heart Transplant Patient: The Role of Endoscopy and Biopsy (ACG 2026) - "However, the differential diagnosis for diarrhea in transplant recipients is broad and includes mycophenolate mofetil (MMF)-associated enterocolitis, inflammatory bowel disease (IBD), and other infectious causes...The leading diagnosis was CMV enteritis; he was started on IV ganciclovir with clinical improvement in symptoms, then discharged on valganciclovir with MMF reduced to 500 mg BID...Figure: Image 1: Colonoscopy demonstrating erythema, absent vascular pattern, friability, and erosions throughout the colon and ileum. From left to right: Ileum, Ascending colon, Sigmoid colon"

Biopsy • Clinical • Acute Kidney Injury • Cytomegalovirus Infection • Gastroenterology • Gastrointestinal Disorder • Immunology • Inflammation • Inflammatory Bowel Disease • Mucositis • Nephrology • Renal Disease • Solid Organ Transplantation • Transplantation

Refractory Dasatinib-Induced Pancolitis: A Case of Dual Biologic Failure (ACG 2026) - "Infectious workup revealed enteropathogenic E. coli, treated with azithromycin without resolution...Repeat colonoscopy demonstrated severe pancolitis (left-predominant) with normal terminal ileum; pathology showed active focal colitis with rare cytomegalovirus (CMV) inclusions, treated with valganciclovir...Notably, this colitis proved exceptionally refractory, failing anti-integrin (vedolizumab) and escalated anti-TNF (infliximab) therapies before responding to anti-IL-23 inhibition (risankizumab-rzaa). Clinicians should maintain high suspicion for TKI-induced colitis in CML patients with chronic diarrhea, as early drug cessation and biologic rotation may be necessary for recovery. Figure: Serial colonoscopy images demonstrating severe, left-predominant dasatinib-induced pancolitis."

Clinical • Chronic Myeloid Leukemia • Cytomegalovirus Infection • Gastroenterology • Gastrointestinal Disorder • Hematological Malignancies • Immunology • Infectious Disease • Inflammatory Bowel Disease • Leukemia • ABL1 • BCR • IL23A

A Double Deception: CMV Gastritis Followed by Pseudo-Malignant Biliary Obstruction in an Immunosuppressed Patient (ACG 2026) - "Case Description/ A 78-year-old man with myasthenia gravis on prednisone and azathioprine presented with nausea, anorexia, and epigastric pain...He improved on ganciclovir, later transitioned to valganciclovir...Figure 2B. CMV immunohistochemical stain (400Ã) highlighting CMV-infected cells within the gastric biopsy specimen."

Clinical • Anorexia • Biliary Cancer • Cholestasis • CNS Disorders • Cytomegalovirus Infection • Gastroenterology • Gastrointestinal Disorder • Hepatology • Myasthenia Gravis • Peptic Ulcer • Solid Tumor

Phase II study of pre-emptive therapy for low-level positive cytomegalovirus antigenemia by low-dose valganciclovir after allogeneic hematopoietic stem cell transplantation (clinicaltrials.gov) - P2 | N=20 | Enrolling by invitation | Sponsor: Dept of Hematology/Oncology, Kyushu University Hospital, Fukuoka, Japan; Kurume Unversity Hospital, Fukuoka, Japan Hamanomachi Hospital, Fukuoka, Japa | Unknown status ➔ Enrolling by invitation

Enrollment open • Bone Marrow Transplantation • Cytomegalovirus Infection • Transplantation

Chronic Graft-Versus-Host Disease Following Intestine, Liver, Pancreas, and Stomach Transplantation (ACG 2026) - "Therapy escalates from everolimus and octreotide to capecitabine and temozolomide, with subsequent disease progression...Dermatology and hematology are consulted, topical steroids are started for the rash and tbo-filgrastim for worsening neutropenia...After refusing cytogam, he returns with rising CMV levels, is treated with IV ganciclovir, and discharged with oral valganciclovir...Persistent donor predominance on STR analysis with cutaneous and bone marrow involvement is shown. Treatment includes corticosteroids, etanercept, photopheresis, ruxolitinib, and supportive care."

Acute Graft versus Host Disease • Cardiovascular • Chronic Graft versus Host Disease • Cytomegalovirus Infection • Gastrointestinal Neuroendocrine Tumor • Graft versus Host Disease • Hematological Disorders • Hepatology • Immunology • Infectious Disease • Leukopenia • Neuroendocrine Tumor • Neutropenia • Pulmonary Disease • Respiratory Diseases • Solid Organ Transplantation • Solid Tumor • Transplantation