Mostafa M Abohelwa1, Mona Ali Hassan2, Jad Zahnan3, Pierre Sfeir4, Aline El Zakhem5, Hadi Skouri3. 1. Department of Internal Medicine, Texas Tech University Health Sciences Center, 3601 4th St, Rm 3b310, Lubbock, TX 79430, USA. 2. Department of Internal Medicine, American University of Beirut Medical Center, ACC Building 6th floor, Beirut 1107-2020, Lebanon. 3. Division of Cardiology, Department of Internal Medicine, American University of Beirut Medical Center, ACC Building 6th floor, Beirut 1107-2020, Lebanon. 4. Division of Cardiothoracic Surgery, Department of Surgery, American University of Beirut Medical Center, ACC Building 6th floor, Beirut 1107-2020, Lebanon. 5. Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center, ACC Building 6th floor, Beirut 1107-2020, Lebanon.
Abstract
BACKGROUND: Cytomegalovirus (CMV) reactivation after placing left ventricular assist device (LVAD) is not a well-known entity with few cases reported in the literature. Here, we are presenting three cases of CMV reactivation after placing LVAD. A literature review of all reported cases in the literature was done. CASE SUMMARY: Three cases of advanced heart failure with reduced ejection fraction (Stage D9) had placed (LVAD) at the American University of Beirut Medical Center, a tertiary care centre in Lebanon. Within the first 2 weeks after LVAD implantation, the three patients spiked a high-grade fever for which sepsis workup was done, and antibiotics were initiated. Despite the escalating antibiotic regimens, the three patients had a persistent high-grade fever. The negative cultures and the continuous fever prompted an investigation for other causes of fever. Therefore, CMV polymerase chain reaction in blood was performed and revealed high titres. Patients received a full course of treatment with ganciclovir. The fever and the CMV titres declined after completing the antiviral therapy with better clinical outcomes. This raises the concern of CMV reactivation in LVAD patients. DISCUSSION: This case series and literature review highlight the epidemiology, incidence, and management of CMV reactivation among LVAD patients. Awareness about this clinical entity should be raised, especially with the increase of LVAD surgeries. Published on behalf of the European Society of Cardiology. All rights reserved.
BACKGROUND: Cytomegalovirus (CMV) reactivation after placing left ventricular assist device (LVAD) is not a well-known entity with few cases reported in the literature. Here, we are presenting three cases of CMV reactivation after placing LVAD. A literature review of all reported cases in the literature was done. CASE SUMMARY: Three cases of advanced heart failure with reduced ejection fraction (Stage D9) had placed (LVAD) at the American University of Beirut Medical Center, a tertiary care centre in Lebanon. Within the first 2 weeks after LVAD implantation, the three patients spiked a high-grade fever for which sepsis workup was done, and antibiotics were initiated. Despite the escalating antibiotic regimens, the three patients had a persistent high-grade fever. The negative cultures and the continuous fever prompted an investigation for other causes of fever. Therefore, CMV polymerase chain reaction in blood was performed and revealed high titres. Patients received a full course of treatment with ganciclovir. The fever and the CMV titres declined after completing the antiviral therapy with better clinical outcomes. This raises the concern of CMV reactivation in LVAD patients. DISCUSSION: This case series and literature review highlight the epidemiology, incidence, and management of CMV reactivation among LVAD patients. Awareness about this clinical entity should be raised, especially with the increase of LVAD surgeries. Published on behalf of the European Society of Cardiology. All rights reserved.
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