Abstract
We report a case of one-year-old boy with juvenile myelomonocytic leukemia (JMML) complicated with mutant cytomegalovirus (CMV) infection after an unrelated allogeneic bone marrow transplantation (UBMT) in whom long term foscarnet (PFA) therapy was effective. As he was three months old at the onset of the disease, it was difficult to distinguish between JMML and perinatal CMV infection because of the presence of CMV antigenemia. He was referred to our hospital for UBMT. CMV antigenemia was negative before UBMT, but became positive on the 26th day after UBMT. The boy was first treated with ganciclovir (GCV) but this was not effective, and treatment was changed to PFA, which was effective for the CMV infection. CMV genotype analysis showed mutation of the CMV DNA polymerase (UL54 subunit) that induced the resistance to GCV but not to PFA. This case suggests that if GCV is not effective for CMV infection, genotype analysis and administration of PFA should be quickly done as the treatment.
