A Case Report of Successful Use of Twice-Daily Letermovir in the Treatment of Resistant Cytomegalovirus in a Small Bowel Transplant Recipient

•First case on the successful use of letermovir in treating cytomegalovirus disease in a small bowel transplant with ganciclovir resistance due to UL97 mutation.•The use of maintenance letermovir prevented the recurrence of the tissue invasive disease and led to clearance or stabilization of the viral load.•Twice-daily dosing of letermovir with lower doses 480 mg orally was used for the first time with fewer gastrointestinal side effects and a similar outcome to 960 mg once daily dosing that was reported in the literature.