Post-CMV organizing pneumonia – An unusual presentation 10 years after kidney transplantation

Abstract

A 45-year-old gentleman underwent kidney transplantation in March 2010. He remained apparently healthy for the next 10 years when he developed anorexia and weight loss. Diagnostic workup revealed cytomegalovirus (CMV) pneumonia. While viremia resolved within 3 weeks of initiation of valganciclovir, he developed progressive breathlessness and hypoxia on exertion. Imaging of thorax revealed central peri-bronchovascular consolidation and fine reticulations with peripheral sparing. Computed tomography (CT)-guided percutaneous lung biopsy revealed organizing intra-alveolar exudates, suggestive of organizing pneumonia, with no evidence of active infection on biopsy as well as bronchoalveolar lavage (BAL) cytology. This atypical pattern of central distribution of opacities is not typical of organizing pneumonia where peripheral subpleural distribution is more common. Patient responded dramatically following escalation of steroids, with complete resolution of infiltrates on follow-up imaging.

Case report: Suspected organizing pneumonia secondary to severe respiratory syncytial virus pneumonia in an elderly patient

“…In addition, SOP after infection, including bacterial, viral, fungal and mycobacterial infections, is the most common ( 10–14 ). SOP can be related to various viral infections, including COVID-19 ( 15 ), influenza virus ( 16 ), herpes virus ( 17 ), and cytomegalovirus ( 18 ). However, SOP after severe RSV pneumonia has rarely been reported.…”