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

Year 2024, Issue: 8, 40 - 44, 29.04.2024

Ahmet Şahin , Alper Şimşek

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.

Keywords

HIV, CMV, Pneumonia

AIDS’te Nadir Pnömoni Sebebi: İki CMV Pnömoni Olgusu

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.

Keywords

HIV, CMV, Pnömoni

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