Life-threatening cytomegalovirus-induced interstitial pneumonitis in a patient of membranous glomerulonephropathy with short-term immune-suppressant therapy

Yen Chung Lin, Der Cherng Tarng

Research output: Contribution to journalArticle

Abstract

Cytomegalovirus (CMV) disease is not uncommon upon an acquired immune compromised status like organ transplant recipients. However, the complication of short-term immunosuppressive therapy for non-transplant patients was not known very well. Here we reported a case of CMV pneumonitis presented with life threatening respiratory failure in a patient with diabetes and steroid-resistant membraneous glomerulonephropathy who underwent immunosuppressant therapy. Chest X-ray and high resolution computed tomography scan revealed interstitial pneumonitis over both lungs. A virus isolation culture of bronchoalveolar lavage fluid and deoxyribonucleic acid polymerase chain reaction in peripheral blood showed positivity for CMV. After one month of ganciclovir therapy, the patient's symptoms improved and lung infiltration resolved. However, post-infection sequela of severe restrictive lung disease occurred and oxygen therapy was maintained after his discharge. CMV lung infection may be mainly due to immune compromised status in the present case of diabetes, steroid-resistant glomerulopathy, and treatment with cyclosporine immunosuppressant. A high index of suspicion and early initiation of antivirus therapy are mandatory for the successful management of opportunistic CMV pneumonitis and the sequelae in patients receiving immunosuppressive therapy.

Original languageEnglish
Pages (from-to)436-440
Number of pages5
JournalJournal of Internal Medicine of Taiwan
Volume21
Issue number6
Publication statusPublished - Dec 2010
Externally publishedYes

Fingerprint

Membranous Glomerulonephritis
Interstitial Lung Diseases
Cytomegalovirus
Immunosuppressive Agents
Lung
Therapeutics
Pneumonia
Steroids
Ganciclovir
Bronchoalveolar Lavage Fluid
Cytomegalovirus Infections
Respiratory Insufficiency
Cyclosporine
Lung Diseases
Thorax
Tomography
X-Rays
Oxygen
Viruses
Transplants

Keywords

  • Cytomegalovirus pneumonitis
  • Immunosuppressive therapy
  • Membranous glomerulonephropathy

ASJC Scopus subject areas

  • Internal Medicine

Cite this

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abstract = "Cytomegalovirus (CMV) disease is not uncommon upon an acquired immune compromised status like organ transplant recipients. However, the complication of short-term immunosuppressive therapy for non-transplant patients was not known very well. Here we reported a case of CMV pneumonitis presented with life threatening respiratory failure in a patient with diabetes and steroid-resistant membraneous glomerulonephropathy who underwent immunosuppressant therapy. Chest X-ray and high resolution computed tomography scan revealed interstitial pneumonitis over both lungs. A virus isolation culture of bronchoalveolar lavage fluid and deoxyribonucleic acid polymerase chain reaction in peripheral blood showed positivity for CMV. After one month of ganciclovir therapy, the patient's symptoms improved and lung infiltration resolved. However, post-infection sequela of severe restrictive lung disease occurred and oxygen therapy was maintained after his discharge. CMV lung infection may be mainly due to immune compromised status in the present case of diabetes, steroid-resistant glomerulopathy, and treatment with cyclosporine immunosuppressant. A high index of suspicion and early initiation of antivirus therapy are mandatory for the successful management of opportunistic CMV pneumonitis and the sequelae in patients receiving immunosuppressive therapy.",
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AB - Cytomegalovirus (CMV) disease is not uncommon upon an acquired immune compromised status like organ transplant recipients. However, the complication of short-term immunosuppressive therapy for non-transplant patients was not known very well. Here we reported a case of CMV pneumonitis presented with life threatening respiratory failure in a patient with diabetes and steroid-resistant membraneous glomerulonephropathy who underwent immunosuppressant therapy. Chest X-ray and high resolution computed tomography scan revealed interstitial pneumonitis over both lungs. A virus isolation culture of bronchoalveolar lavage fluid and deoxyribonucleic acid polymerase chain reaction in peripheral blood showed positivity for CMV. After one month of ganciclovir therapy, the patient's symptoms improved and lung infiltration resolved. However, post-infection sequela of severe restrictive lung disease occurred and oxygen therapy was maintained after his discharge. CMV lung infection may be mainly due to immune compromised status in the present case of diabetes, steroid-resistant glomerulopathy, and treatment with cyclosporine immunosuppressant. A high index of suspicion and early initiation of antivirus therapy are mandatory for the successful management of opportunistic CMV pneumonitis and the sequelae in patients receiving immunosuppressive therapy.

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