Case Report
BibTex RIS Cite

A Rare Cause of Pneumonia in AIDS: Two Cases of CMV Pneumonia

Year 2024, Issue: 8, 40 - 44, 29.04.2024
https://doi.org/10.58252/artukluhealth.1475143

Abstract

Introduction: Human Immunodeficiency Virus (HIV) may cause morbidity and mortality in patients due to opportunistic infections. Cytomegalovirus, one of these opportunistic infections, is a double-stranded DNA virus and belongs to the Herpesviridae family.
Case report: Our first case was a 48-year-old heterosexual woman who presented with fever, cough and marked dyspnea. Her husband had been diagnosed with HIV infection 3 years ago. Laboratory examination confirmed the diagnosis of HIV/AIDS and the presence of cytomegalovirus. HIV RNA: 94500 copies/ml, CMV PCR: 83730 IU/mL, CD4 count was 30 cells/mm3. Thoracic computed tomography showed diffuse budding tree branch appearances in the upper and lower lobes of both lungs. Our second case was a 40-year-old heterosexual male who presented with dyspnea and cough. He had a history of unprotected sexual intercourse. He had been diagnosed with HIV infection at another health institution last year but had not used antiretroviral therapy. Chest radiography showed patchy infiltration and thorax tomography showed diffuseground-glass densities in both lungs. HIV RNA: 755200 copies/ml, CMV PCR: 41970 IU/mL, CD4 count was 7 cells/mm3. CMV PCR in broncho alveolar lavage fluid: 9482 IU/mL. In both cases, Ehrlich-Ziehl-Neelsen in sputum was negative, Pneumocystis jirovecii antibody and galactomannan antigen were negative in the tests performed for opportunistic pathogens. Both of our patients had CD4 counts <50 cells/mm3 and had advanced stage AIDS.
Conclusion: Cytomegalovirus pneumonia was diagnosed with clinical, radiologic and laboratory findings and valganciclovir was started. After valganciclovir, dyspnea, fever and cough regressed. Patients were discharged after continuing their antiretroviral treatment. In this case report, we aimed to present a rare case of cytomegalovirus pneumonia in patients with AIDS.

References

  • Benito, N., Moreno, A., Miro, J. M., &Torres, A. (2012). Pulmonary infections in HIV-infected patients: an update in the 21st century. EurRespir J, 39(3), 730-745. https://doi.org/10.1183/09031936.00200210
  • Colugnati, F. A., Staras, S. A., Dollard, S. C., & Cannon, M. J. (2007). Incidence of cytomegalovirus infection among the general population and pregnant women in the United States. BMC Infect Dis, 7, 71. https://doi.org/10.1186/1471-2334-7-71
  • Çölkesen, F., Onur, U., Demir, N. A., & Sümer, Ş. (2019). Sitomegalovirüs pnömonisi saptanan bir AIDS olgusu. Genel Tıp Dergisi, 29(3), 150-153.
  • Du, C. J., Liu, J. Y., Chen, H., Yan, S., Pu, L., Xiong, H. F., Xiang, P., Li, C. S., Zhang, M., Xie, R. M., Chen, B. D., & Li, A. (2020). Differences and similarities of high-resolution computed tomography features between pneumocystis pneumonia and cytomegalovirus pneumonia in AIDS patients. Infect Dis Poverty, 9(1), 149. https://doi.org/10.1186/s40249-020-00768-2
  • Gianella, S., & Letendre, S. (2016). Cytomegalovirus and HIV: A Dangerous Pas de Deux. J Infect Dis, 214 Suppl 2 (Suppl 2), S67-74. https://doi.org/10.1093/infdis/jiw217
  • Goud, T., & Ramesh, K. (2014). Opportunistic infections among HIV patients attending Tertiary care hospital, Karnataka, India. International Journal of current microbiology and applied sciences, 3(4), 824-829.
  • Grønborg, H. L., Jespersen, S., Hønge, B. L., Jensen-Fangel, S., & Wejse, C. (2017). Review of cytomegalovirus coinfection in HIV-infected individuals in Africa. Rev Med Virol, 27(1). https://doi.org/10.1002/rmv.1907
  • Herry, I., Cadranel, J., Antoine, M., Meharzi, J., Michelson, S., Parrot, A., Rozenbaum, W., & Mayaud, C. (1996). Cytomegalovirus-induced alveolar hemorrhage in patients with AIDS: a new clinical entity ? Clin Infect Dis, 22(4), 616-620. https://doi.org/10.1093/clinids/22.4.616
  • Ho, M. (1990). Epidemiology of cytomegalovirus infections. Rev Infect Dis, 12 Suppl 7, S701-710. https://doi.org/10.1093/clinids/12.supplement_7.s701
  • Huang, L., & Crothers, K. (2009). HIV-associated opportunistic pneumonias. Respirology, 14(4), 474-485. https://doi.org/10.1111/j.1440-1843.2009.01534.x
  • Jabbehdari, S., Marjani, M., Moniri, A., Baghaei, P., Mansouri, D., Sadr, M., Azimi, M., Dorudinia, A., Nadji, S., & Tabarsi, P. (2022). Cytomegalovirus pneumonia in HIV-infected patients: case series from Iran [journal article]. HIV & amp; AIDS Review. International Journal of HIV-Related Problems, 21(4), 327-331. https://doi.org/10.5114/hivar.2022.120159
  • Ljungman, P., Boeckh, M., Hirsch, H. H., Josephson, F., Lundgren, J., Nichols, G., Pikis, A., Razonable, R. R., Miller, V., & Griffiths, P. D. (2017). Definitions of Cytomegalovirus Infection and Disease in Transplant Patients for Use in Clinical Trials. Clin Infect Dis, 64(1), 87-91. https://doi.org/10.1093/cid/ciw668
  • Özkısa, T., Turhan, U., Aydoğan, M., Yücel, O., Kılıç, E., & Gümüş, S. (2017). Buzlu Cam Opasitesi Olan Hastalarda HIV Enfeksiyonu Düşünmek. İzmir Göğüs Hastanesi Dergisi, 31(2), 101-104.
  • Ramesh, K., Gandhi, S., & Rao, V. (2015). Clinical profile of human immunodeficiency virus patients with opportunistic infections: A descriptive case series study. Int J Appl Basic Med Res, 5(2), 119-123. https://doi.org/10.4103/2229-516x.157166
  • Razonable, R. R., & Humar, A. (2013). Cytomegalovirus in solid organ transplantation. Am J Transplant, 13 Suppl 4, 93-106. https://doi.org/10.1111/ajt.12103
  • Salomon, N., Gomez, T., Perlman, D. C., Laya, L., Eber, C., & Mildvan, D. (1997). Clinical features and outcomes of HIV-related cytomegalovirus pneumonia. Aids, 11(3), 319-324. https://doi.org/10.1097/00002030-199703110-00009
  • Sinclair, J., & Sissons, P. (2006). Latency and reactivation of human cytomegalovirus. J Gen Virol, 87 (Pt 7), 1763-1779. https://doi.org/10.1099/vir.0.81891-0
  • Styczynski, J. (2018). Who Is the Patient at Risk of CMV Recurrence: A Review of the Current Scientific Evidence with a Focus on Hematopoietic Cell Transplantation. Infect Dis Ther, 7(1), 1-16. https://doi.org/10.1007/s40121-017-0180-z
  • Waxman, A. B., Goldie, S. J., Brett-Smith, H., & Matthay, R. A. (1997). Cytomegalovirus as a primary pulmonary pathogen in AIDS. Chest, 111(1), 128-134. https://doi.org/10.1378/chest.111.1.128
  • Zhao, M., Zhuo, C., Li, Q., & Liu, L. (2020). Cytomegalovirus (CMV) infection in HIV/AIDS patients and diagnostic values of CMV-DNA detection across different sample types. Ann Palliat Med, 9(5), 2710-2715. https://doi.org/10.21037/apm-20-1352

AIDS’te Nadir Pnömoni Sebebi: İki CMV Pnömoni Olgusu

Year 2024, Issue: 8, 40 - 44, 29.04.2024
https://doi.org/10.58252/artukluhealth.1475143

Abstract

Giriş: İnsan İmmün Yetmezlik Virüsünün (HIV) neden olduğu fırsatçı enfeksiyonlar nedeni ile hastalarda morbidite ve mortalite görülebilmektedir.
Olgu sunumu: İlk olgumuz; ateş, öksürük ve belirgin dispne, şikayeti ile başvuran 48 yaşında heteroseksüel kadın idi. Eşi 3 yıl önce HIV enfeksiyonu tanısı almıştı. Hastanın laboratuvar incelemesinde HIV/AIDS tanısı ve sitomegalovirüs varlığı doğrulandı. HIV RNA: 94500 kopya/ml, CMV PCR: 83730 IU/mL, CD4 sayısı 30 hücre/mm3 idi. Toraks bilgisayarlı tomografisinde her iki akciğer üst ve alt lobda yaygın tomurcuklanan ağaç dalı görünümleri izlendi. İkinci olgumuz ise dispne ve öksürük şikayeti ile başvuran 40 yaşında heteroseksüel erkek idi. Korunmasız cinsel ilişki öyküsü mevcuttu. Geçen yıl başka bir sağlık kuruluşunda HIV enfeksiyonu tanısı almış ancak antiretroviral tedavisini kullanmamıştı. Akciğer grafisinde yamalı infiltrasyon, toraks tomografisinde ise her iki akciğerde yaygın buzlu cam dansiteleri izlendi. HIV RNA: 755200 kopya/ml, CMV PCR: 41970 IU/mL, CD4 sayısı 7 hücre/mm3 idi. Bronkoalveolar lavaj sıvısında CMV PCR: 9482 IU/mL olarak saptandı. Olguların her ikisinde de fırsatçı patojenlere yönelik bakılan tetkiklerde balgamda Ehrlich-Ziehl-Neelsen boyama negatif, Pneumocystisjirovecii antikor testi negatif, galaktomannan antijeni negatif idi. Her iki olgumuzun da CD4 sayıları <50 hücre/mm3 olup ileri evre AIDS hastası olmaları idi.
Sonuç: Klinik, radyolojik ve laboratuvar bulgularla sitomegalovirüs pnömonisi tanısı konuldu ve hastalara valgansiklovir başlandı. Valgansiklovir sonrasında hastaların dispne, ateş ve öksürük şikayetleri regreseoldu.Hastalar antiretroviral tedavilerine devam edilerek taburcu edildi. Bu olgu sunumunda AIDS’li hastalarda nadir görülen sitomegalovirüs pnömoni olgularının sunulması amaçlandı.

References

  • Benito, N., Moreno, A., Miro, J. M., &Torres, A. (2012). Pulmonary infections in HIV-infected patients: an update in the 21st century. EurRespir J, 39(3), 730-745. https://doi.org/10.1183/09031936.00200210
  • Colugnati, F. A., Staras, S. A., Dollard, S. C., & Cannon, M. J. (2007). Incidence of cytomegalovirus infection among the general population and pregnant women in the United States. BMC Infect Dis, 7, 71. https://doi.org/10.1186/1471-2334-7-71
  • Çölkesen, F., Onur, U., Demir, N. A., & Sümer, Ş. (2019). Sitomegalovirüs pnömonisi saptanan bir AIDS olgusu. Genel Tıp Dergisi, 29(3), 150-153.
  • Du, C. J., Liu, J. Y., Chen, H., Yan, S., Pu, L., Xiong, H. F., Xiang, P., Li, C. S., Zhang, M., Xie, R. M., Chen, B. D., & Li, A. (2020). Differences and similarities of high-resolution computed tomography features between pneumocystis pneumonia and cytomegalovirus pneumonia in AIDS patients. Infect Dis Poverty, 9(1), 149. https://doi.org/10.1186/s40249-020-00768-2
  • Gianella, S., & Letendre, S. (2016). Cytomegalovirus and HIV: A Dangerous Pas de Deux. J Infect Dis, 214 Suppl 2 (Suppl 2), S67-74. https://doi.org/10.1093/infdis/jiw217
  • Goud, T., & Ramesh, K. (2014). Opportunistic infections among HIV patients attending Tertiary care hospital, Karnataka, India. International Journal of current microbiology and applied sciences, 3(4), 824-829.
  • Grønborg, H. L., Jespersen, S., Hønge, B. L., Jensen-Fangel, S., & Wejse, C. (2017). Review of cytomegalovirus coinfection in HIV-infected individuals in Africa. Rev Med Virol, 27(1). https://doi.org/10.1002/rmv.1907
  • Herry, I., Cadranel, J., Antoine, M., Meharzi, J., Michelson, S., Parrot, A., Rozenbaum, W., & Mayaud, C. (1996). Cytomegalovirus-induced alveolar hemorrhage in patients with AIDS: a new clinical entity ? Clin Infect Dis, 22(4), 616-620. https://doi.org/10.1093/clinids/22.4.616
  • Ho, M. (1990). Epidemiology of cytomegalovirus infections. Rev Infect Dis, 12 Suppl 7, S701-710. https://doi.org/10.1093/clinids/12.supplement_7.s701
  • Huang, L., & Crothers, K. (2009). HIV-associated opportunistic pneumonias. Respirology, 14(4), 474-485. https://doi.org/10.1111/j.1440-1843.2009.01534.x
  • Jabbehdari, S., Marjani, M., Moniri, A., Baghaei, P., Mansouri, D., Sadr, M., Azimi, M., Dorudinia, A., Nadji, S., & Tabarsi, P. (2022). Cytomegalovirus pneumonia in HIV-infected patients: case series from Iran [journal article]. HIV & amp; AIDS Review. International Journal of HIV-Related Problems, 21(4), 327-331. https://doi.org/10.5114/hivar.2022.120159
  • Ljungman, P., Boeckh, M., Hirsch, H. H., Josephson, F., Lundgren, J., Nichols, G., Pikis, A., Razonable, R. R., Miller, V., & Griffiths, P. D. (2017). Definitions of Cytomegalovirus Infection and Disease in Transplant Patients for Use in Clinical Trials. Clin Infect Dis, 64(1), 87-91. https://doi.org/10.1093/cid/ciw668
  • Özkısa, T., Turhan, U., Aydoğan, M., Yücel, O., Kılıç, E., & Gümüş, S. (2017). Buzlu Cam Opasitesi Olan Hastalarda HIV Enfeksiyonu Düşünmek. İzmir Göğüs Hastanesi Dergisi, 31(2), 101-104.
  • Ramesh, K., Gandhi, S., & Rao, V. (2015). Clinical profile of human immunodeficiency virus patients with opportunistic infections: A descriptive case series study. Int J Appl Basic Med Res, 5(2), 119-123. https://doi.org/10.4103/2229-516x.157166
  • Razonable, R. R., & Humar, A. (2013). Cytomegalovirus in solid organ transplantation. Am J Transplant, 13 Suppl 4, 93-106. https://doi.org/10.1111/ajt.12103
  • Salomon, N., Gomez, T., Perlman, D. C., Laya, L., Eber, C., & Mildvan, D. (1997). Clinical features and outcomes of HIV-related cytomegalovirus pneumonia. Aids, 11(3), 319-324. https://doi.org/10.1097/00002030-199703110-00009
  • Sinclair, J., & Sissons, P. (2006). Latency and reactivation of human cytomegalovirus. J Gen Virol, 87 (Pt 7), 1763-1779. https://doi.org/10.1099/vir.0.81891-0
  • Styczynski, J. (2018). Who Is the Patient at Risk of CMV Recurrence: A Review of the Current Scientific Evidence with a Focus on Hematopoietic Cell Transplantation. Infect Dis Ther, 7(1), 1-16. https://doi.org/10.1007/s40121-017-0180-z
  • Waxman, A. B., Goldie, S. J., Brett-Smith, H., & Matthay, R. A. (1997). Cytomegalovirus as a primary pulmonary pathogen in AIDS. Chest, 111(1), 128-134. https://doi.org/10.1378/chest.111.1.128
  • Zhao, M., Zhuo, C., Li, Q., & Liu, L. (2020). Cytomegalovirus (CMV) infection in HIV/AIDS patients and diagnostic values of CMV-DNA detection across different sample types. Ann Palliat Med, 9(5), 2710-2715. https://doi.org/10.21037/apm-20-1352
There are 20 citations in total.

Details

Primary Language Turkish
Subjects Medical Infection Agents
Journal Section Case Reports
Authors

Ahmet Şahin

Alper Şimşek

Publication Date April 29, 2024
Published in Issue Year 2024 Issue: 8

Cite

APA Şahin, A., & Şimşek, A. (2024). AIDS’te Nadir Pnömoni Sebebi: İki CMV Pnömoni Olgusu. Artuklu Health(8), 40-44. https://doi.org/10.58252/artukluhealth.1475143