Kang G W, Hong H L, Lee I H, Ahn K S, Kim J D, Choi D L
Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea.
Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea.
Transplant Proc. 2016 May;48(4):1208-11. doi: 10.1016/j.transproceed.2016.01.021.
Cytomegalovirus (CMV) infection in patients with liver transplantation (LT) remains a highly prevalent complication with a significant increase in morbidity and mortality. However, CMV-associated meningoencephalitis is rarely diagnosed, and treatment is very difficult. The aim of the present report is to review the experience of successful treatment with combined ganciclovir and foscarnet of CMV-associated meningoencephalitis refractory to ganciclovir alone in a hemodialysis (HD) patient after LT. A 54-year-old woman with end-stage renal disease on HD developed a seizure with loss of consciousness. She had received a liver transplant 4 months before. Blood CMV polymerase chain reaction was positive, and cerebrospinal fluid (CSF) analysis was compatible with viral meningitis. Brain magnetic resonance imaging (MRI) showed extensive dural thickening with enhancement and a round ring-like enhancement in the left centrum semiovale. She was diagnosed with CMV-associated meningoencephalitis. At that time, ganciclovir was started intravenously. After that, there were no improvements in mental state, CSF analysis, or brain MRI. Intravenous foscarnet at reduced dose was added to ganciclovir therapy. With combined ganciclovir and foscarnet, there was a slight improvement in her mental state and brain MRI.
肝移植（LT）患者的巨细胞病毒（CMV）感染仍然是一种高度普遍的并发症，发病率和死亡率显著增加。然而，CMV相关性脑膜脑炎很少被诊断出来，且治疗非常困难。本报告的目的是回顾在一名LT术后接受血液透析（HD）的患者中，联合使用更昔洛韦和膦甲酸钠成功治疗对单独使用更昔洛韦难治的CMV相关性脑膜脑炎的经验。一名54岁接受HD治疗的终末期肾病女性出现癫痫发作并伴有意识丧失。她在4个月前接受了肝移植。血液CMV聚合酶链反应呈阳性，脑脊液（CSF）分析结果与病毒性脑膜炎相符。脑部磁共振成像（MRI）显示硬脑膜广泛增厚并强化，左侧半卵圆中心有环形强化。她被诊断为CMV相关性脑膜脑炎。当时，开始静脉注射更昔洛韦。此后，其精神状态、CSF分析或脑部MRI均无改善。在更昔洛韦治疗中添加了低剂量静脉注射膦甲酸钠。联合使用更昔洛韦和膦甲酸钠后，她的精神状态和脑部MRI有轻微改善。
