Abstract
A 55-year-old man was referred for acute kidney failure. He had undergone a kidney transplantation for focal segmental glomerulosclerosis 6 months before admission. Medical history consisted of hypertension, hypercholesterolemia, monoclonal gammopathy of unknown significance (IgM λ), and tertiary hyperparathyroidism secondary to chronic kidney disease. After anti-thymocyte globulin induction, the maintenance regimen consisted of azathioprine, tacrolimus, and corticosteroids. His baseline creatinine level was around 150 μmol/L, no proteinuria was detected, and a 3-month protocol graft biopsy was unremarkable. Three months after kidney transplantation, the patient developed primary cytomegalovirus infection despite valganciclovir prophylactic treatment in the setting of donor cytomegalovirus positive and recipient negative. No specific organ involvement was detected, and a ganciclovir-based regimen was started. Because of persistent viremia, 2 months after ganciclovir treatment, cytomegalovirus antiviral resistance testing was performed and a UL97 ganciclovir resistance mutation was detected. I.v. foscarnet treatment was initiated at 100 mg/kg per day.
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