CMV pneumonia following Temozolomide in Primary CNS Lymphoma

Temozolomide (TMZ) is a second-generation alkylating agent introduced to therapy of primary brain tumors. Using TMZ there is an increased risk of infection. Literature reported several cases of PJ pneumonia but only 6 cases of CMV disease. This case presented the 1st patient with persistent CMV reactivation and CMV disease previously not treated with Rituximab. A 44-year-old man was diagnosed with a occipital-PCNSL. As salvage treatment he was started with whole brain radiotherapy in association with TMZ. After some days CMV-DNA on blood resulted positive so a preemptive tp was commenced. After 2 weeks of Ganciclovir treatment it was replaced with Foscavir for persistent CMV-DNA positivity and the appearance of respiratory failure symptoms, highly suggested for CMV pneumonia.After 5 weeks of treatment,the patient improved and the CMV load became negative.