Two Cases of Congenital Cytomegalovirus Infection in which Treatment was Successfully Continued with G-CSF for Severe Neutropenia During Valganciclovir Therapy

Abstract

　　Two cases of congenital cytomegalovirus infection in which treatment was successfully continued with G-CSF for severe neutropenia during valganciclovir therapy

Background: Valganciclovir (VGCV) therapy has been shown to improve hearing and neurodevelopmental outcomes in infants with symptomatic congenital cytomegalovirus (CMV) infection. However, neutropenia is a common adverse effect of VGCV treatment. Case presentation: We report two infants with symptomatic congenital CMV infection who developed severe neutropenia during VGCV therapy. In case 1, the neutrophil count decreased to 392/μL on day 49 of life. In case 2, severe neutropenia (<500/μL) occurred on days 43, 44, and 50. In both cases, granulocyte colony-stimulating factor (G-CSF) was administered, resulting in rapid recovery of neutrophil counts. VGCV therapy was continued without interruption after G-CSF administration. Both patients completed antiviral treatment without serious complications, and no hearing impairment or developmental delay has been observed to date. Conclusion: In infants with congenital CMV infection who develop severe neutropenia during VGCV therapy, administration of G-CSF may allow continuation of antiviral treatment without discontinuation.