ID Fellows Cup Question 21

J is a 45 year-old with history of living donor kidney transplant 9 months prior presents with progressive wasting and diarrhea despite 3 weeks of valganciclovir therapy for CMV syndrome. Repeat CMV quant from blood has increased from 7,000 to 19,000. J feels ill and is unable to keep up with fluid intake prompting admission to hospital. The allograft is functioning well with creatinine in normal range at baseline and current labs consistent only with mild dehydration. A resistance panel returns showing a UL97 & UL54 Resistance mutation to ganciclovir.

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