Fig. 1

Time course of antiviral treatments and events. The CMV DNA loads (detection limit of 50 international units per ml (IU/ml)) were determined on serum samples. CMV DNA loads below the lower limit of quantization (125 IU/ml) are not to scale. The durations and the daily dosages of anti-CMV treatments with valganciclovir (450 mg or 900 mg twice a day) and letermovir are shown as black and grey boxes, respectively. Acyclovir (400 mg twice a day) was administered, when valGCV was paused. First detection of mutation C325Y (cytosine at amino acid 325 to tyrosine) in the specimens is depicted by a black star. The retrospective analysis revealed that the mutation was already present in earlier specimens shown by white stars. CsA, cyclosporine A; LMV, letermovir; valGCV, valganciclovir. ACV, acyclovir