Abstract: SA-PO963

A Unique Case of Valganciclovir Associated Reversible Azoospermia in a Renal Transplant Patient

Session Information

Category: Nephrology Education

  • 1302 Fellows and Residents Case Reports

Authors

  • Lee, Al Jonathan, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States
  • Vela-Ortiz, Myriam C., Drexel University College of Medicine, Philadelphia, Pennsylvania, United States
  • Ranganna, Karthik M., Drexel University College of Medicine, Philadelphia, Pennsylvania, United States
  • Aggarwal, Sandeep, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States
Background

Azospermia with secondary infertility has not been reported as an adverse effect associated with valgancyclovir. We present a case of reversible azospermia in a renal transplant patient associated with valgancyclovir therapy.

Methods

30y/o male with past medical history of surgically corrected Tetralogy of Fallot whom developed dialysis dependent renal failure post cardiac surgery and required renal transplant 11 years ago. Patient presented for routine outpatient transplant appointment with complaints of inability to conceive. He denied genitourinary trauma, ED dysfunction, family history of infertility, or exogenous use of androgens. He was a well-nourished, well developed male who appeared as stated age and had an unremarkable physical exam. Referral was made to fertility clinic. The patient’s semen analysis results are: semen volume 3.8mL and no sperm identified. Diagnosis of primary male infertility secondary to azopsermia was made. At this time the patient was on stable immunosuppression with tacrolimus 1mg BID and prednisone 5mg daily and valgancyclovir 900mg BID (for 3 years)secondary to persistent EBV viremia. Autoimmune, hormonal, and radiological workup for infertility was negative. In an attempt to uncover medication related azospermia, valgancyclovir was stopped. 1 month later repeat semen analysis results were: semen volume 2.9mL, sperm concentration 21mil/mL, total sperm number 60.9mil/ejac, progressive motility 41%, total motility 63%, vitality N/P, sperm morphology 3%, pH 8, leukocyte <1. There were no further other medication changes. Patient was able to conceive a child and had semen cryopreserved. Patient currently not on valgancyclovir with stable EBV PCR of 7272 copies/mL; unchanged since initial stoppage of valgancyclovir 10 months prior.

Conclusion

In animal studies gancyclovir has been a potent inhibitor of spermatogenesis but to our knowledge this is the first human reported case of valgancyclovir associated azospermia. Further studies needed including careful post-marketing analysis to confirm this association.