Korean J Infect Dis.  2002 Aug;34(4):261-266.

Human Cytomegalovirus Pneumonia and Pulmonary Aspergillosis in a Patient with Acute Myelogenous Leukemia following Chemotherapy

• Kim GB
• Choi SM
• Lee DG
• Kim HR
• Lee KW
• Nam KW
• Kwok SK
• Son DK
• Chang JH
• Choi JH
• Shin WS
• Kim CC

Abstract

Cytomegalovirus (CMV) pneumonia is one of the major causes of morbidity and mortality in immunocompromised patients such as transplant recipients. But CMV pneumonia is unusually reported among adults with leukemia who have not undergone transplantation. Because it is a cause of life-threatening pneumonia in adults with leukemia receiving potent immunosuppressive therapies, CMV has emerged as an important pathogen. We report a case of CMV pneumonia and invasive pulmonary aspergillosis in a patient with acute leukemia who have not undergone transplantation. A 31-year-old man with acute myelogenous leukemia developed high fever on day 9 of second consolidation chemotherapy. Six days later, chest radiography showed patchy consolidation with central cavity on right upper lung. Considering fungal pneumonia, amphoterin B was started, then fever was subsided. Chest CT showed necrotizing pneumonia with cavity formation in posterior segment of right upper lobe. Because of several episodes of hemoptysis, lobectomy was performed. Grossly, the area of focal necrosis with central cavity formation and multiple small interstitial nodules were observed. In the area of interstitial nodules, giant cells with intranuclear inclusion and perinuclear halo were found. In the area of focal necrosis, fungal hyphae with acute branching and septation were found. Ganciclovir and immunoglobulin were administered for CMV pneumonia. On day 62 of the chemotherapy, the patient discharged with improved symptoms. After several weeks, unrelated HLA-matched allogeneic stem cell transplantation was performed. On day 14 of transplantation, the patient died due to septic shock of unknown cause.

Keyword

Cytomegalovirus pneumonia; Leukemia; Aspergillosis

MeSH Terms

Adult
Aspergillosis
Consolidation Chemotherapy
Cytomegalovirus*
Drug Therapy*
Fever
Ganciclovir
Giant Cells
Hemoptysis
HMGB1 Protein
Humans*
Hyphae
Immunocompromised Host
Immunoglobulins
Intranuclear Inclusion Bodies
Invasive Pulmonary Aspergillosis
Leukemia
Leukemia, Myeloid, Acute*
Lung
Mortality
Necrosis
Pneumonia*
Pulmonary Aspergillosis*
Radiography
Shock, Septic
Stem Cell Transplantation
Thorax
Tomography, X-Ray Computed
Transplantation
Ganciclovir
HMGB1 Protein
Immunoglobulins