Pneumonia associated with rising cytomegalovirus antibody titres in a healthy adult.

Abstract

3 x 106 cells/I with 6% monocytes, 6% basophils, 60% eosinophils, 21% lymphocytes, and 7% polymorphonuclear leucocytes on differential count. The red cell count was 7-5 x 107/1. The pleural fluid protein concentration was 52 g/l, glucose 110 mg/dl (6 mmol/l) and lactate dehydrogenase 400 IU/l. The arterial blood oxygen tension was 82 mmHg (10-9 kPa) with the patient breathing air. Ventilation-perfusion lung scintigraphy showed a nonsegmental defect at the right base, which was interpreted as being unlikely to be due to pulmonary embolism. A tuberculin test gave a negative result. Pleural fluid culture was negative for viral and bacterial pathogens and cytological examination gave negative results. Blood, sputum, and urine cultures were negative for bacterial pathogens. The serum cytomegalovirus infection titre by indirect immunofluorescence was 1/512 in the acute phase and rose to 1:16 384 five weeks after the onset of the patient's illness, at which time he was symptom free and the chest radiograph showed that the pulmonary inflltrate and pleural fluid had cleared. A repeat test for antinuclear antibody was negative. The patient remains in good health after 18 months of follow up. DiscussionCytomegalovirus infection pneumonia is most commonly seen in the compromised host. The most common cause of viral pneumonia in immunocompromised patients is cytomegalovirus infection, which has a predilection for recipients of organ transplants.2 In this setting pulmonary manifestations range from peribronchovascular consolidation or miliary nodules to diffuse consolidation.3 Rare cases of unilateral consolidation4 have been described and there has been a single case report of necropsy proved cytomegalovirus infection pneumonia in a compromised patient presenting as a solitary pulmonary nodule.s Although radiological evidence of cytomegalovirus pneumonia in the normal host is unusual, the resolution of the abnormalities as the clinical features subsided, together with the rise in cytomegalovirus infection titre, makes cytomegalovirus pneumonia the most likely cause of the acute illness in our patient. The course of spontaneous cytomegalovirus infection in previously healthy adults is usually that of a mild illness characterised by malaise, fever, atypical lymphocytosis, abnormal results in liver function tests, and negative heterophil agglutination.' Exudative pharyngitis is typi-957 on 11 April 2019 by guest. Protected by copyright.

Pleural effusions induced by human herpesviruses in the immunocompetent host

“…Cases of alpha-herpesvirinae related PEs in the immune-competent host. Idell and co-workers[33] reported a case of acute CMV-induced pneumonia and eosinophilic PE in a healthy 21-year-old man. Pleural fluid culture tested negative for viral and bacterial pathogens while CMV infection was confirmed by means of indirect immunofluorescence in serum sample.…”