91: Troll of Transplantation 3

This podcast episode addresses the diagnostic and therapeutic challenges of cytomegalovirus (CMV) infection in a post-lung transplant adolescent with cystic fibrosis. The discussion centers on differentiating between CMV infection and disease, emphasizing risk factors such as donor/recipient serostatus, age, immunosuppression regimens, and the transplanted organ. The experts highlight the importance of early bronchoscopy to distinguish between rejection and infection, and they explore various diagnostic tests, including quantitative PCR for viruses and fungal complement fixation tests. The conversation covers empiric antimicrobial strategies, potential ganciclovir resistance, and alternative treatments like foscarnet and mirabivir, while also considering the impact of CMV retinitis. Ultimately, the patient's fatal outcome underscores the complexities of managing infections in immunocompromised transplant recipients.