Medical image of the week: cytomegalovirus pneumonia

• Main Authors: Reyes N, Weiel JJ, Bracamonte ER, Snyder L
• Format: Article
• Language: English
• Published: Arizona Thoracic Society 2013-10-01
• Series: Southwest Journal of Pulmonary and Critical Care
• Subjects: cytomegalovirus; pneumonia; owl's eye; lobar; renal transplantation; immunocompromised host; valgangcyclovir
• Online Access: http://www.swjpcc.com/imaging/2013/10/2/medical-image-of-the-week-cytomegalovirus-pneumonia.html

No abstract available. Article truncated after 150 words. A 29 year-old female with a history of systemic lupus erythematosus presented with a seven-day history of fever, dyspnea and a non-productive cough. She underwent renal transplantation four weeks prior to admission and was maintained on mycophenolate, tacrolimus, prednisone and prophylactic fluconazole, trimethoprim/sulfamethoxazole and valgangcyclovir. A CT chest was performed (Figure 1) and revealed left lower lobe consolidation. A BAL was performed in the left lower lobe and the cell count revealed 50% lymphocytes, 13% neutrophils and 37% macrophages. The BAL Papanicolaou stain showed enlarged cytomegalovirus-infected pneumocytes with the characteristic “owl’s eye” appearance (Figures 2 and 3). CMV quantitative PCR from serum resulted 648,615 IU/m. The BAL culture grew CMV. The patient was started on treatment with valgangcyclovir with clinical improvement. While often thought of as a “pneumonitis” with diffuse infiltrates, CMV can cause a lobar pneumonia in up to 30% of patients. Prophylaxis is effective, but cases can occur …