Cytovene (ganciclovir) / Roche - LARVOL DELTA

Diverticular perforation with exclusive local invasion in cytomegalovirus infection during ganciclovir treatment: an autopsy case report. (PubMed, Ann Med Surg (Lond)) - "An 83-year-old woman with prolonged methotrexate and steroid use for rheumatoid arthritis was referred to our hospital due to hypotension, hypoxemia, and altered mental status following bloody stools. Ganciclovir failed to prevent focal bowel perforation, although it may have eradicated CMV within rectal ulcer lesions. Clinicians should be aware that CMV infection can present as diverticular perforation due to localized invasion, even during antiviral therapy."

Journal • Colorectal Cancer • Critical care • Cytomegalovirus Infection • Gastroenterology • Gastrointestinal Disorder • Hematological Disorders • Hepatology • Hypotension • Immunology • Infectious Disease • Inflammatory Arthritis • Liver Failure • Rheumatoid Arthritis • Rheumatology • Septic Shock

Uncommon cells in cerebrospinal fluid in Japanese encephalitis: A case report. (PubMed, Medicine (Baltimore)) - "Transient uncommon CSF cells in this case of JE may exhibit morphological features resembling siderophages or malignant tumor cells, thus requiring a comprehensive correlation between cytomorphological findings and both clinical and laboratory data. This case highlights CSF cytology's diagnostic value in central nervous system infections while cautioning against overreliance on isolated cellular findings. Effective collaboration between clinicians and cytologists is essential to prevent misdiagnosis and ensure appropriate therapeutic guidance."

Journal • Cerebral Hemorrhage • CNS Disorders • Hematological Disorders • Infectious Disease • Oncology • Pain • Solid Tumor

Good syndrome presenting with multiple pulmonary infections: a case report involving metagenomic sequencing diagnosis. (PubMed, Front Med (Lausanne)) - "This patient received an intensified anti-infective regimen, with broad-spectrum carbapenem, meropenem, as the backbone therapy, combined with antifungal agents and antiviral treatment (IV ganciclovir and oral molnupiravir). After aggressive anti-infection therapy, the patient experienced clinical improvement, and chest CT demonstrated significant radiographic improvement. Although intravenous immunoglobulin (IVIG) is foundational in GS, intensive antimicrobial therapy is also critical for clinical outcomes."

Journal • Cough • Cytomegalovirus Infection • Epstein-Barr Virus Infections • Herpes Simplex • Infectious Disease • Novel Coronavirus Disease • Primary Immunodeficiency • Respiratory Diseases • Solid Tumor • Thymoma • Thymus Cancer

In vitro study: No displacement of bilirubin-albumin binding by erythromycin, azithromycin, acyclovir, or ganciclovir. (PubMed, Pediatr Int) - No abstract available

Journal • Preclinical • Infectious Disease

Evaluation of Ganciclovir Dosing Strategies for the Treatment of Cytomegalovirus (IDWeek 2025) - No abstract available

Cytomegalovirus Infection • Infectious Disease

CMV Gastritis Following Pembrolizumab in Stage IV Renal Cell Carcinoma: Importance of Early PCR and Biopsy for Timely Diagnosis (ACG 2025) - "Upon confirmation, infliximab was discontinued, steroids were tapered, and the patient was transitioned to IV ganciclovir followed by oral valganciclovir. She remained on omeprazole 40 mg twice daily...Initiating immunosuppression without a definitive diagnosis may exacerbate viral disease. In ICI-treated patients with gastritis symptoms, early biopsy with CMV staining should be considered.Figure: Endoscopic image demonstrating erythematous and edematous gastric mucosaFigure: Endoscopic image showing inflamed gastric mucosa with yellowish exudate and frothy secretion"

Biopsy • Metastases • Anorexia • Clear Cell Renal Cell Carcinoma • Cytomegalovirus Infection • Dermatology • Gastroenterology • Gastrointestinal Disorder • Genito-urinary Cancer • Immunology • Infectious Disease • Oncology • Renal Cell Carcinoma • Solid Tumor

Post-HSCT Viral Management: Strategies Beyond the Guidelines (ICBMT 2025) - "Despite the integration of Letermovir into standard prophylaxis regimens, breakthrough infections persist, especially beyond D+100, with Korean real - world data showing clinically significant CMV infection (csCMVi) rates rising from 9.5% at 14 weeks to 29.4% by 24 weeks...We present a real -world case of ganciclovir -resistant CMV harbouring the UL97 H520Q mutation, which necessitated sequential therapy with foscarnet and later maribavir...Prophylaxis with oral acyclovir for up to one year reduces early incidence but carries rebound risks and is limited by long -term toxicity and antiviral resistance. The advent of the recombinant zoster vaccine (RZV; Shingrix) offers a promising preventive strategy, particularly in the 6 –24 month window post -transplant...Optimal outcomes require a personalised, adaptive strategy that incorporates novel therapeutics, surveillance tools, and host factors. Through real -world evidence and clinical insight, this lec ture aims to equip..."

Bone Marrow Transplantation • Cytomegalovirus Infection • Graft versus Host Disease • Hematological Malignancies • Herpes Zoster • Immunology • Infectious Disease • Varicella Zoster

A Case of Cytomegalovirus-Associated Gastric Ulcer Causing Hemorrhagic Shock in a Pre-Liver Transplant Patient (ACG 2025) - "Hospital course was also notable for large volume paracentesis and autoimmune hemolytic anemia, requiring blood transfusion and dexamethasone course. Importantly, the patient had not yet undergone liver transplantation or initiated immunosuppressive therapy when the ulcer developed, though she had been treated with rituximab and a short course of steroids for autoimmune hemolytic anemia. Fortunately, she was able to clear the viremia with a course of IV ganciclovir despite starting immunosuppression following her liver transplant.Figure: Diffuse ulceration of Incisura and gastric body on EGDFigure: Ulceration along the incisura extending proximally along the gastric body, retroflexed stomach view"

Clinical • Anemia • Autoimmune Hemolytic Anemia • Cardiovascular • Cytomegalovirus Infection • Fibrosis • Gastroenterology • Gastrointestinal Disorder • Hematological Disorders • Hepatology • Hypotension • Immunology • Infectious Disease • Inflammatory Bowel Disease • Nephrology • Peptic Ulcer • Renal Disease • Septic Shock • Transplantation

No Stone Left Unturned: Rapid Induction of Remission With Upadacitinib Followed by Cytomegalovirus (CMV)-Colitis in a Hospitalized Patient With Crohn's Disease (CD) (ACG 2025) - "Introduction: Patients with CD who develop severe symptoms often require hospitalization for rapid induction of remission to improve symptoms and prevent progression of complications.Case Description/ A 60-year-old woman with ulcerative proctitis (diagnosis changed to CD due to penetrating perianal disease) on mesalamine, hydrocortisone enemas, and prednisone 20mg (taper) presented with severe rectal pain and bloody diarrhea...She was started on IV methylprednisolone...CMV infection resolved with ganciclovir. While this patient had a rapid initial response to off-label, high-intensity upadacitinib, she subsequently demonstrated clinical deterioration ultimately undergoing colectomy for suspected refractory CD...Repeat colonoscopy following upadacitinib rescue therapy (bottom two images).Figure: Figure 2. Admission timeline and CRP trend."

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

The Intersection of CMV and IBD in an Immunosuppressed Host (ACG 2025) - "We present a case of CMV colitis in an individual with no known prior IBD.Case Description/ A 66-year-old woman with hyperlipidemia, hypertension, type 2 diabetes mellitus, and psoriatic arthritis on methotrexate, golimumab, and folate (previously Humira) presents with sudden explosive diarrhea and rectal bleeding...A prednisone taper was started, but continued symptoms prompted readmission...IV ganciclovir was initiated and transitioned to oral valganciclovir with partial improvement...Thus, her Simponi (golimumab) frequency was increased to biweekly, leading to normalization of CRP and calprotectin improvement from 2800 to 2000. However, residual symptoms prompted a switch to Risankizumab. This case illustrates the diagnostic and therapeutic challenges of distinguishing CMV colitis from IBD flare in immunosuppressed patients, the importance of tissue-based CMV testing, and the need for both antiviral and optimized immunosuppressive therapy to achieve remission.Figure:..."

Cardiovascular • Crohn's disease • Cytomegalovirus Infection • Diabetes • Dyslipidemia • Gastroenterology • Gastrointestinal Disorder • Hypertension • Immunology • Inflammation • Inflammatory Arthritis • Inflammatory Bowel Disease • Metabolic Disorders • Psoriatic Arthritis • Rheumatology • Seronegative Spondyloarthropathies • Type 2 Diabetes Mellitus • Ulcerative Colitis

An Unusual Culprit: CMV Colitis-Induced Protein-Losing Enteropathy in an Immunocompetent Adult (ACG 2025) - "On day 44, IV methylprednisolone (20 mg twice daily) and a second course of ganciclovir were started...He was discharged on a steroid taper and valganciclovir for 6 weeks...Decline despite antivirals prompted evaluation for concomitant causes. Findings on repeat colonoscopy, and rapid and sustained clinical recovery with combined antiviral and steroid therapy, supports CMV as the etiology and underscores the need for reassessment when disease course is atypical.Figure: Figure 1: Alternate Etiologies Considered and Excluded"

Clinical • Cytomegalovirus Infection • Gastroenterology • Gastrointestinal Disorder • Immunology • Infectious Disease • Inflammation • Respiratory Diseases

From Varices to Viral Infiltrate: Diagnosing CMV Gastritis in a Cirrhotic, Immunocompromised Host (ACG 2025) - "We present a case of biopsy-proven CMV gastritis in a patient with metabolic-associated steatohepatitis (MASH) cirrhosis and chronic B-cell depletion from long-term rituximab therapy.Case Description/ A 68-year-old woman with compensated MASH cirrhosis, morbid obesity, rheumatoid arthritis (on rituximab for 9 years), interstitial lung disease (on fluticasone furoate/umeclidinium/vilanterol), atrial fibrillation on anticoagulation, prediabetes, hypothyroidism, and depression underwent upper endoscopy for variceal screening...Concurrent plasma CMV DNA by NAAT was elevated at 5,530 IU/mL.Given her immunocompromised status, close coordination with the infectious disease team was undertaken, and the patient was initiated on intravenous ganciclovir therapy. This case highlights the importance of maintaining a broad differential diagnosis when evaluating gastric mucosal changes in immunosuppressed patients with cirrhosis...Histologic evaluation remains essential, especially in..."

Atrial Fibrillation • Cardiovascular • CNS Disorders • Cytomegalovirus Infection • Depression • Dermatology • Endocrine Disorders • Fibrosis • Gastroenterology • Gastrointestinal Disorder • Genetic Disorders • Hepatology • Immunology • Infectious Disease • Inflammatory Arthritis • Interstitial Lung Disease • Metabolic Disorders • Metabolic Dysfunction-Associated Steatohepatitis • Obesity • Portal Hypertension • Psychiatry • Pulmonary Disease • Respiratory Diseases • Rheumatoid Arthritis • Rheumatology • CD68

Mycophenolate Mofetil-Induced Ileitis and Colitis Following Chemotherapy (ACG 2025) - "MMF-induced ileitis is rarer than colitis, occurring in less than 1% of patients.Case Description/ A 53-year-old female with kidney transplants in 1994 and 2004 on tacrolimus, MMF, and prednisone as well as recent diagnosis of Stage II colon adenocarcinoma status post right hemicolectomy with end-side anastomosis, presented with severe watery diarrhea leading to significant acute kidney injury (AKI). Symptoms began following cycle three of adjuvant Capecitabine and Oxaliplatin (CAPOX) therapy...Findings were initially concerning for Cytomegalovirus (CMV) enteritis and colitis in an immunocompromised patient and empiric antiviral treatment with ganciclovir was administered...Endoscopic image of the neo-terminal ileum with severe circumferential edema, erythema, and deep cratered ulcers.Figure: Figure 2. Pathology image (low power view) of colonic biopsy showing architectural disturbance with irregularly-shaped crypts and focal crypt drop-out (H&E, 40x)."

Acute Kidney Injury • Colon Adenocarcinoma • Colon Cancer • Colorectal Adenocarcinoma • Colorectal Cancer • Cytomegalovirus Infection • Dermatology • Gastroenterology • Gastrointestinal Disorder • Immunology • Nephrology • Renal Disease • Solid Organ Transplantation

Gastric CMV Presenting in an Immunosuppressed Patient With Multiple Sclerosis (ACG 2025) - "We present a case of biopsy positive gastric CMV in a patient with MS receiving treatment with natalizumab.Case Description/ A 65-year-old female with a history of GERD on omeprazole twice daily and multiple sclerosis on natalizumab presented to the ED with abdominal bloating and epigastric pain. There is typically a good response to treatment with ganciclovir. While our patient significantly improved without need for antiviral treatment, this case further emphasizes the importance of monitoring for atypical infections in immunocompromised patients.Figure: CMV inclusion cells with positive staining."

Clinical • CNS Disorders • Cytomegalovirus Infection • Gastroenterology • Gastroesophageal Reflux Disease • Gastrointestinal Disorder • Hematological Disorders • Hepatology • Immunology • Infectious Disease • Inflammation • Leukopenia • Multiple Sclerosis

Biopsy Beyond the Surface: A Challenging Case of Refractory Diarrhea Secondary to CAR-T Therapy (ACG 2025) - "However, persistent, steroid-refractory diarrhea may represent a rare but emerging complication: CAR-T–associated GI lymphoproliferative (LP) disorders.Case Description/ A 70-year-old female with multiple myeloma presented with chronic, non-bloody, mucoid diarrhea ( >5 episodes/day) seven months after Cilta-cel CAR-T therapy...CMV DNA PCR was mildly elevated (555 copies/mL) and was refractory to ganciclovir and empiric antibiotics...Cyclosporine is thought to treat this condition by uniquely targeting persistent engineered CAR-T cells by inhibiting IL-2-mediated mucosal proliferation and is administered at 3–5 mg/kg/day with goal troughs between 150–250 ng/mL. Given the similarity between CAR-T cell lymphoma and IBD, further research is needed on the potential role of biologics in treating this rare disease entity"

Biopsy • Clinical • Gastrointestinal Disorder • Graft versus Host Disease • Hematological Malignancies • Immunology • Infectious Disease • Influenza • Lymphoma • Multiple Myeloma • Pneumonia • Rare Diseases • Respiratory Diseases • T Cell Non-Hodgkin Lymphoma • CD8 • GZMB

A Rare Presentation of Adult-Onset Still's Disease Overlapping Autoimmune Hepatitis (ACG 2025) - "Figure Prednisone and Ganciclovir were initiated with rising CMV PCR titers up to 1000 U/L. After transaminase improvement, she was discharged on a steroid taper, azathioprine and valganciclovir...Anakinra (IL-1 receptor antagonist) was started with significant improvement...Mild bile duct injury is also identified. There is no evidence of ductopenia."

Clinical • Autoimmune Hepatitis • Dermatology • Hepatology • Hodgkin Lymphoma • Immunology • Infectious Disease • Inflammation • Liver Failure • Pruritus • Rheumatology • IL18

A Gut Feeling Gone Wrong: Unmasking CMV Colitis in IBD Flare (ACG 2025) - "Ganciclovir monotherapy was partially effective, prompting reintroduction of steroids and azathioprine. Infliximab was withheld due to concerns of antibody formation and lack of reliable outpatient follow-up due to incarceration...The use of corticosteroids and other immunomodulators, while necessary for controlling IBD flares, can promote viral reactivation by impairing T-cell mediated immunity. This case emphasizes the fragile balancing act required: treating the viral infection enough to control CMV without undermining the control of IBD activity."

Anemia • Bone Marrow Transplantation • Cytomegalovirus Infection • Gastroenterology • Gastrointestinal Disorder • Hematological Disorders • Human Immunodeficiency Virus • Immunology • Infectious Disease • Inflammation • Inflammatory Bowel Disease • Ulcerative Colitis

An Uncommon Culprit: CMV Pouchitis Mimicking Crohn's-Like Disease of the Pouch (ACG 2025) - "In 2023, she was treated with Risankizumab for CLDP with primary non-response...She was referred to our institution on Ustekinumab every 4 weeks and Azathioprine 125 mg daily...Patient required hospitalization locally and is currently being treated with intravenous ganciclovir with improvement of symptoms. A high index of suspicion is needed to diagnose CMV pouchitis, especially in patients who are immunosuppressed and have not responded to conventional therapies...A repeat endoscopic exam after antiviral treatment is recommended to document mucosal healing, CMV eradication, and exclude Crohn's disease.Figure: Figure 1: A, B, and C: Pouchoscopy findings of pre pouch ileum inflammation, demonstrating deep and confluent ulcerations, consistent with cytomegalovirus infection. D: Rectal cuff with ulcerations, which was also affected by cytomegalovirus infection.Figure: Figure 2: Sections of ulcerated pre pouch ileum, with visible viral cytopathic effect within..."

Crohn's disease • Cytomegalovirus Infection • Dermatology • Gastroenterology • Gastrointestinal Disorder • Immunology • Infectious Disease • Inflammation • Inflammatory Bowel Disease • Ulcerative Colitis

The Colitis Conundrum: Recurrent C. difficile and CMV Colitis in a Patient With Underlying Ulcerative Colitis (ACG 2025) - "Prior C. diff infections were resistant to vancomycin and metronidazole, only improving with fidaxomicin...He was treated with Bezlotoxumab, but follow-up colonoscopy with biopsy showed pancolitis with CMV-infected cells...He also failed UC treatment with infliximab...Colonoscopy after treatment with fecal live-brpk capsules, ganciclovir, and upadacitinib. Rectosigmoid junction shows quiesced inflammation with endoscopic healing."

Clinical • Cytomegalovirus Infection • Gastroenterology • Gastrointestinal Disorder • Immunology • Infectious Disease • Inflammation • Inflammatory Bowel Disease • Ulcerative Colitis

Beyond the Colon: Hepatobiliary CMV as a Rare End-Organ Manifestation of AIDS (ACG 2025) - "He had been out of HIV care for over a year after previously being on Biktarvy and Prezcobix...Initial stool studies were positive for cryptosporidium, and nitazoxanide was initiated...Ganciclovir was initiated and transitioned to valganciclovir 900 mg BID...Treatment included antiviral therapy. This case underscores the importance of a broad differential, timely biopsy, and multidisciplinary care in managing complex presentations of AIDS-related GI and hepatobiliary disease.Figure: MRI showing Dilated intrahepatic bile ducts with beaded appearance of ductal dilatation."

Cytomegalovirus Infection • Gastroenterology • Gastrointestinal Disorder • Hepatology • Human Immunodeficiency Virus • Immunology • Infectious Disease • CD4

Optimizing Ganciclovir and Valganciclovir Therapy in Lung Transplant Recipients: A Population Pharmacokinetic Approach (ERS 2025) - No abstract available

Clinical • PK/PD data • Transplantation

Beyond the Colon: Rare Jejunal CMV Ulcer in an Immunosuppressed Patient (ACG 2025) - "We presenta case of jejunal CMV ulceration in a kidney transplant recipient on chronic immunosuppression.Case Description/ A 46-year-old male with focal segmental glomerulosclerosis, status post-deceased donor kidney transplant (DDKT), maintained on tacrolimus and belatacept, presented with worsening sharp upper abdominal pain, bloating, nausea, diarrhea, anorexia, and a35-pound weight loss over three months...Intravenous ganciclovir is the preferred initial treatment, often followed by oral valganciclovir formaintenance...Delay inrecognition can result in severe complications, including stricture, bleeding, or perforation. This case highlights the importance of considering CMV enteritis in transplant recipients with persistent GI symptoms and supports the utility of pushenteroscopy for diagnosis when conventional EGD is inconclusive.Figure: Figure 1CT abdomen showing enteritis and features suggestive of small bowel obstructionFigure: Figure 2Clean base ulcer in the jejunum"

Clinical • Anorexia • Chronic Kidney Disease • Cytomegalovirus Infection • Focal Segmental Glomerulosclerosis • Gastrointestinal Disorder • Glomerulonephritis • Infectious Disease

Triple Infection in an Immunosuppressed Host: CMV Colitis With Enteropathogenic E. coli Diarrhea and EBV Viremia (ACG 2025) - "We present a complex case of CMV colitis in a kidney transplant recipient, complicated by concurrent enteropathogenic Escherichia coli (EPEC) diarrhea and Epstein–Barr virus (EBV) viremia.Case Description/ A 68-year-old male with end-stage renal disease status post bilateral sequential kidney transplants, maintained on mycophenolate, belatacept, and low-dose steroids, presented with five days of non-bloody diarrhea and right upper quadrant pain...Subsequently, the patient developed bilateral CMV retinitis.Treatment was initiated with intravenous ganciclovir due to the extent of viremia and tissue-invasive disease, later transitioning to oral valganciclovir...Multidisciplinary management, including ganciclovir therapy and immunosuppressive adjustment, led to clinical improvement. This case underscores the need for early detection and tailored treatment in complex post-transplant scenarios.Figure: Figure 1: Positive CMV immunohistochemical stain of colonic mucosa biopsy at..."

Cytomegalovirus Infection • Dermatology • Epstein-Barr Virus Infections • Gastroenterology • Gastrointestinal Disorder • Genetic Disorders • Hepatology • Immunology • Infectious Disease • Inflammation • Nephrology • Ocular Inflammation • Ophthalmology • Renal Disease • Retinal Disorders • Solid Organ Transplantation

CMV Colitis Presenting as Inflammatory Polyposis in a Patient With Common Variable Immunodeficiency (ACG 2025) - "Oral valganciclovir is the standard treatment for CMV and typically is as efficacious as IV ganciclovir. Right: Multiple sessile inflammatory polyps.Figure: Figure 2: Left: H&E stain of inflammatory polyp, highlighting area of granulation tissue and dense chronic inflammation. Right: Scattered CMV inclusions present in stromal and endothelial cells (identified by immunohistochemistry)."

Clinical • Anemia • Cardiovascular • Cytomegalovirus Infection • Gastroenterology • Gastrointestinal Disorder • Genetic Disorders • Hematological Disorders • Immunology • Infectious Disease • Inflammation • Interstitial Lung Disease • Primary Immunodeficiency • Pulmonary Arterial Hypertension • Pulmonary Disease • Respiratory Diseases

CMV Infection During Pregnancy in a Recent Liver Transplant Recipient: A Case Report (ACG 2025) - "Following LT, the immunosuppressive regimen consisted of mycophenolate mofetil, tacrolimus, as well as TMP-SMX and valganciclovir (VGV) for prophylaxis...Following a risk/benefit discussion, the decision was made to continue with pregnancy and initiate treatment for CMV with IV ganciclovir to protect against liver graft failure and fetal complications...Given the immunocompromised state of the transplant population and use of teratogenic medications to help prevent liver rejection and acute infections, pregnancies need to be carefully planned so as to minimize harm to both fetus and mother. This case highlights a rare occurrence of CMV infection during pregnancy following LT and highlights the importance of thorough birth control counseling and monitoring in women of child-bearing age."

Case report • Clinical • CNS Disorders • Cytomegalovirus Infection • Hepatology • Infectious Disease • Liver Failure • Long-acting Reversible Contraceptives • Obstetrics • Transplantation • Ventriculomegaly