Resistant/refractory Cytomegalovirus (CMV) infection is an important threat in the management of solid organ transplant recipients, often associated with poor outcomes. We describe the case of a heart-transplanted patient who developed primary CMV infection with fever and subsequent appearance of resistance to ganciclovir and maribavir during antiviral treatment, and with important toxicity due to foscarnet. The outcome was good with reduced-dose continuous infusion of foscarnet. Further research is needed to improve the management of difficult-to-treat CMV infection.
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