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cytomegalovirus (CMV) pneumonitis
Epidemiology:
1) occurs in heart & lung transplant recipients
2) risk of severe or fatal disease is greatest in CMV mismatched patients, i.e. CMV+ donor, CMV- recipient
Clinical manifestations:
1) generally occurs 6-12 weeks post transplant when immuno- suppression is maximal
2) low-grade fever
Laboratory:
1) complete blood count (CBC) generally shows leukopenia
2) arterial blood gas (ABG) generally shows hypoxemia
Radiology:
- chest X-ray generally shows hazy infiltrate
Complications:
1) active CMV infection predisposes to rejection by upregulation of HLA antigens on the transplanted organ
2) bacterial or fungal superinfection
3) accelerated transplant vasculopathy
Management:
- ganciclovir IV, followed by several months of oral therapy to prevent relapse
Notes:
- case report of CMV pneumonitis developing in a 63 year old woman after treatment for newly diagnosed dermatomyositis [2]
Related
cytomegalovirus (CMV, human herpesvirus 5, HHV5)
General
pneumonitis
viral infection
References
- Medical Knowledge Self Assessment Program (MKSAP) 11, American
College of Physicians, Philadelphia 1998
- Letourneau AR, Price MC, Azar MM.
Case 26-2017 - A 63-Year-Old Woman with Fever, Hypotension,
and Hypoxemia.
N Engl J Med 2017; 377:770-778. August 24, 2017
PMID: 28834480
http://www.nejm.org/doi/full/10.1056/NEJMcpc1616402