Managing refractory cytomegalovirus in an immunosuppressed patient with sarcoidosis: a case report on maribavir therapy

Cytomegalovirus (CMV) is a common herpesvirus that can cause severe infections in immunocompromised patients. Standard treatments, such as ganciclovir and valganciclovir, are usually effective, but refractory CMV requires alternatives like foscarnet, cidofovir, or immunotherapies. New treatments, such as maribavir, have shown promise for refractory cases. This report discusses a woman in her 50s with sarcoidosis, previously treated with infliximab, leflunomide, and hydroxychloroquine, who developed refractory CMV. Initial treatment with ganciclovir and intravenous immunoglobulin (IVIG) was discontinued due to severe pancytopenia, leading to the initiation of foscarnet. Despite this, CMV viremia persisted, leading to off-label use of maribavir, which reduced the viral load with mild gastrointestinal side effects. The patient also developed haemophagocytic syndrome, complicating her condition. Unfortunately, she succumbed to an opportunistic infection, leaving the complete efficacy of maribavir unconfirmed. This case highlights the potential of novel antiviral agents and underscores the need for further research on refractory CMV management.