Reactions 1680, p149 - 2 Dec 2017
Right bundle branch block: case report
A 12-year-old boy developed right bundle branch block
(RBBB) during treatment with ganciclovir [Cymevene; dosage
and duration of treatment to reaction onset not stated].
The boy was hospitalised due to chest pain and shortness of
breath. He initially developed runny nose, fever and cough,
which later progressed to chest pain and shortness of breath
over 10 days. Upon hospitalisation, he developed tachypnoea,
tachycardia and fever. Subsequently, he was started on
empirical treatment with various IV unspecified antibiotics.
However, his condition continued to deteriorate, and required
ventilatory support. Thereafter, his antibiotic therapy was
upgraded, but he developed severe acute respiratory distress
syndrome and septic shock. After that, unspecified antifungals
were also added to his treatment regimen, and inotropic
support was provided. Despite receiving aggressive treatment,
his condition continued to worsen and he developed
hypotension, acute kidney injury and multi organ failure. Later,
lung biopsy was performed, which led to the diagnosis of CMV
pneumonitis. Hence, his treatment was initiated with IV
ganciclovir. The treatment resulted in a significant
improvement, and his fever subsided. The inotropic support
and ventilation were withdrawn. However, during the
treatment he developed RBBB.
The boy’s ganciclovir dose was reduced, and RBBB resolved.
He recovered completely, and was discharged after 21 days of
Author comment: "During Ganciclovir treatment course,
the patient developed right bundle branch block (RBBB)
probably as a rare side effect of Ganciclovir therapy. . .Rather
than using a sole clinical judgment, score of 5 on Naranjo
causality scale,indicates a probable relationship between
Ganciclovir administration and RBBB."
Al-Eyadhy AA, et al. Cytomegalovirus associated severe pneumonia, multi-organ
failure and Ganciclovir associated arrhythmia in immunocompetent child. Journal
of Infection and Chemotherapy 23: 844-847, No. 12, Dec 2017. Available from:
URL: http://doi.org/10.1016/j.jiac.2017.08.003 - Saudi Arabia
Reactions 2 Dec 2017 No. 16800114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved