Cytomegalovirus acute infection with pulmonary involvement in an immunocompetent patient

Abstract

IntroductionCytomegalovirus (CMV) infection in healthy adults is usually asymptomatic or causes a mild mononucleosis syndrome, while severe infections are rare in immunocompetent patients and poorly documented. When described, gastrointestinal tract and the central nervous systems are the most frequent sites of severe CMV infection. Lung disease can occur, but it’s rare.Clinical caseA 29 years old man presenting with a 2-weeks history of fever, headache, malaise, dry non-productive cough and thoracic pleuritic pain, without improvement after one-week therapy with levofloxacin. Blood exams showed lymphocytosis of almost 50%, nine percent of atypical lymphocytes and elevated transaminases. Thoracic CT-scan showed bilateral infiltrate with internal air bronchogram. Blood serology showed positivity for CMV IgG and IgM, with low CMV IgG avidity. Serum and bronchoalveolar detection of CMV by polymerase chain reaction (PCR) technique was also positive. Cultures were all negative. The patient became increasingly hypoxemic and the liver transaminases worsening, the reason for which ganciclovir was started. He made a full recovery and was discharged seven days later with oral valganciclovir, completing a 3 weeks antiviral course at home.DiscussionCMV pneumonia is a rare condition, however it’s one of the three most common cause of severe viral community acquired pneumonia (CAP), along with influenza and adenovirus. CMV pneumonia should be considered in patients with atypical lymphocytes and mildly elevated serum transaminases.ConclusionIn immunocompetent hosts, even with severe CMV-CAP, the prognosis is good. However, antiviral treatment should be considered in the rare occasion of severe CMV infection. Nevertheless, more studies are needed to clarify the clinical benefit of antiviral treatment.

Battle between Host Immune Cellular Responses and HCMV Immune Evasion

“…Although the available antiviral drugs (ganciclovir, forscarnet and cidofovir) reduced the mortality caused from early HCMV effects, the reduction of mortality from late HCMV diseases still remains questionable [18]. The direct clinical effects of HCMV infections on patients post HSCT include pneumonia, gastrointestinal diseases, retinitis and CNS disorders [19,20,21]; the indirect manifestation include accelerated arthrosclerosis and bacterial or fungal super-infections. A bidirectional link between HCMV and graft versus host disease (GvHD) has been observed.…”

Human cytomegalovirus pneumonia in an immunocompetent patient: a very uncommon but treatable condition

“…We gathered a total of 16 previous cases of diagnosed CMV pneumonia in immunocompetent patients, with our case being the 17th. This is presented in table 1 8 10–24…”

Cytomegalovirus (CMV) Pneumonitis: Cell Tropism, Inflammation, and Immunity

“…Interestingly, all of the aforementioned high-risk groups for HCMV pneumonitis show impairment in T cell immunity already indicating a relevant role for this immune cell type. Nevertheless, rare cases of HCMV pneumonitis have been observed in immune competent patients thus implying that also determinants of pathogenicity encoded by the virus may be causative for lung disease [13,14,15].…”