Case report: Maribavir as salvage therapy for multidrug-resistant CMV DNAemia in a non-transplant patient with ocular cicatricial pemphigoid.

Cytomegalovirus (CMV) is a significant cause of morbidity in immunocompromised patients, particularly those receiving chronic systemic therapy for autoimmune diseases such as ocular cicatricial pemphigoid (OCP). While the novel oral agent maribavir is approved for refractory CMV in post-transplant recipients, data regarding its efficacy in non-transplant populations remain scarce. We report the case of a 45-year-old female with OCP and comorbid Crohn's disease who developed multidrug resistant (MDR) CMV gastroenterocolitis. After failing sequential therapy with ganciclovir and foscarnet due to the emergence of UL97 (M460V/I) and UL54 (V781I) mutations, she achieved complete virological clearance with maribavir. This case highlights a novel, off-label application of maribavir in a non-transplant host with complex iatrogenic immunosuppression and sequential multidrug resistant CMV, demonstrating its role as a potent salvage therapy that avoids the nephrotoxicity associated with traditional agents.