Success and failure of artesunate treatment in five transplant recipients with disease caused by drug-resistant cytomegalovirus

• Clinical efficiency of artesunate in resistant CMV infections is controversial.
• We describe 5 cases of multidrug-resistant CMV infections treated with artesunate.
• Clinical outcomes was favourable in 3 cases and unfavourable in 2 cases.
• Artesunate was useful in decreasing CMV DNA load in multidrug-resistant CMV strains.
• Artesunate was insufficient for the treatment of severe illness with organ injury.

Cytomegalovirus (CMV) strains resistant to ganciclovir, cidofovir and/or foscarnet were genotypically and phenotypically characterised in two haematopoietic stem cell transplant recipients and three solid-organ transplant recipients with CMV disease. The anti-malaria drug artesunate led to a favourable virological and clinical response in three cases with mild CMV diseases (fever and neutropaenia) but was ineffective in two fatal CMV diseases with lung involvement in spite of a decrease in the CMV DNA load in blood and bronchoalveolar fluid.