Intrathecal cytomegalovirus immunoglobulin for CMV encephalitis post allogeneic stem cell transplantation

Ian Pang; Sanjay Singhabahu; Igor Novitzky-Basso; Tony Mazzulli; Shahid Husain; Jonas Mattsson

doi:10.1016/j.idcr.2022.e01608

Intrathecal cytomegalovirus immunoglobulin for CMV encephalitis post allogeneic stem cell transplantation

IDCases. 2022 Aug 19:29:e01608. doi: 10.1016/j.idcr.2022.e01608. eCollection 2022.

Authors

Ian Pang¹, Sanjay Singhabahu¹, Igor Novitzky-Basso¹, Tony Mazzulli², Shahid Husain³, Jonas Mattsson¹

Affiliations

¹ Hans Messner Allogeneic Transplant Program, Princess Margaret Cancer Centre, University Health Network, 610 University Ave, Toronto, ON M5G 2C1, Canada.
² Department of Microbiology, Sinai Health System/University Health Network, 600 University Ave, Toronto, ON M5G 1X5, Canada.
³ Division of Infectious Diseases, Toronto General Hospital, University Health Network, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada.

Abstract

We report the outcome of a 43 year old man who developed fatal ventriculoencephalitis due to cytomegalovirus (CMV) infection 7 months post allogeneic stem cell transplant. He failed multiple lines of treatment, including intravenous ganciclovir, foscarnet, and CMV-specific immunoglobulins, without improvement in CSF CMV copies. Novel intrathecal administration of CMV immunoglobulins was given but did not lead to clearance of CMV from CSF. No adverse effects related to intrathecal CMV immunoglobulins were observed. Notably, throughout this period, CMV in blood remained undetectable. This case highlights the difficulty in treating CMV encephalitis, and that novel therapeutic approaches are needed.

Keywords: Allogeneic hematopoietic stem cell transplantation; Cytomegalovirus; Encephalitis.

Publication types

Case Reports