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

Chang Ahn Seol; Young Jin Ko; Sung-Han Kim; Mi-Na Kim; Heungsup Sung; Je-Hwan Lee

doi:10.5145/ACM.2015.18.2.64

Journal List > Ann Clin Microbiol > v.18(2) > 1078538

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Seol, Ko, Kim, Kim, Sung, and Lee: The First Case of Ganciclovir-Resistant Cytomegalovirus Colitis with a 597-600 Deletion in UL97 Gene after Stem Cell Transplantation in Korea

Original Article

Ann Clin Microbiol 2015;18(2):64-67.

Published online: 5 June 2015

DOI: https://doi.org/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

Chang Ahn Seol¹, Young Jin Ko¹, Sung-Han Kim², Mi-Na Kim¹, Heungsup Sung¹, Je-Hwan Lee²

¹Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Koera$$check country spealing

²Department of Internal Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Koera$$check country spealing

Correspondence: Heungsup Sung, Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea. (Tel) 82-2-3010-4499, (Fax) 82-2-478-0884, (E-mail) sung@amc.seoul.kr

Received 23 March 201526 May 2015 Accepted 27 May 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

초록

Human cytomegalovirus (CMV) infection has been a major concern in hematopoietic stem cell transplant recipients. Ganciclovir (GCV) resistance results most-ly 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 haploidentical peripheral blood stem cell transplantation (h-PBSCT) in a 46 year-old man with myelodys-plastic 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.

Keywords: Cytomegalovirus, Drug resistance, Ganciclovir, UL97

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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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