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CASE REPORT article
Front. Immunol.
Sec. Alloimmunity and Transplantation
Volume 16 - 2025 | doi: 10.3389/fimmu.2025.1521763
Maribavir for refractory cytomegalovirus viremia after renal transplantation in a child with Schimke's immune-osseous dysplasia
Provisionally accepted
Jia-shuan Huang 1,2
Hongkai Wang 2,3
Li-Ping Rong 1*
Xiaoyun Jiang 4
Longshan Liu 5 Liu-Yi Huang 4 Na Zhang 4 Zhi-Hui Yue 4*- 1 Department of Pediatrics, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
- 2 Medical College, Sun Yat-sen University, Guangzhou, China
- 3 Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- 4 Pediatrics Department, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- 5 Organ Transplantation Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
Cytomegalovirus (CMV) is a major and opportunistic pathogen in recipients of solid organ transplants. Maribavir, a pUL97 protein kinase inhibitor, was approved to treat refractory post-transplant CMV infections in the US in 2021. However, it is currently rarely used in pediatrics worldwide. Here, we report a case of a Chinese boy with Schimke's immune-osseous dysplasia (SIOD) who developed refractory CMV infection after renal transplantation. An 11-year-old boy was hospitalized with recurrent abdominal andtesticular pain 50 days after renal transplantation. Diagnoses included urinary tract infection, epididymitis, CMV viremia, chronic kidney disease stage 2, and SIOD. After five days of treatment, his pain improved, but he developed persistent fever and shortness of breath. Blood CMV levels rose to 1.64 x 10^5 copies/ml after one month of ganciclovir treatment. Significant bone marrow suppression was observed after combined treatment with foscarnet. Anti-rejection treatment was ceased due to compromised immune function. On day 40, with parental consent, Maribavir was initiated, resulting in undetectable CMV copies within four days. His clinical status and bone marrow suppression improved. Continuing Maribavir for two weeks led to the disappearance of CMV viremia, no bone marrow suppression, and normal liver and kidney functions.This case demonstrates the successful short-term use of Maribavir in treating refractory CMV infection in an immune-deficient child post-renal transplantation. Further studies are needed to explore the efficacy and safety of Maribavir in pediatrics.
Keywords: CMV, cytomegalovirus GCV, Schimke's immune-osseous dysplasia, Children, renal transplant
Received: 02 Nov 2024; Accepted: 17 Mar 2025.
Copyright: © 2025 Huang, Wang, Rong, Jiang, Liu, Huang, Zhang and Yue. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Li-Ping Rong, Department of Pediatrics, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, China
Zhi-Hui Yue, Pediatrics Department, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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