A Case Report: Ganciclovir Therapy of Cytomegalovirus Pneumonitis

Min, Jee Yeon; Hong, Soo Jong; Moon, Hyung Nam; Hong, Chang Yee

Abstract

Ganciclovir is an antiviral agent that is effective for cytomegalovirus (CMV) infection in immunocompromised hosts. But the benefits of treatment for the congenital CMV diseases are still controversial. Cytomegalovirus pneumonitis is very rare. And so, a few cases of ganciclovir therapy in CMV pneumonitis were reported. We experienced a case of a 7 month-old male infant with prolonged pneumonitis and respiratory difficulty which were not improved with steroid and antibiotic therapy for 2 months. He was born at gestational age of 32 weeks and received oxygen therapy with mask for 2 days only. On physical examination, tachypnea, chest retracion, inspiratory wheezing and rales were present. PaCO2 was 84.0 mmHg on blood gas analysis and the anti-CMV-IgM, -IgG antibodies were positive. But anti-CMV-IgM, -IgG antibodies of his mother were negative. The open lung biopsy revealed CMV inclusion in alveolar interstitium. CMV shell vial assay of patient's urine and tracheal aspirate were positive. Ganciclovir (5-10 mg/kg, 10weeks) had been given without any significant complications. After treatment of ganciclovir for 4 weeks, shell vial assay of tracheal aspirate for CMV showed negative conversion and anti-CMV-IgM antibody was converted negatively. CMV pneumonitis of this patient had the possibility of secondary infection associated with immunosuppressive status after long-term steroid therapy or with blood transfusion. We report a first case of ganciclovir therapy of CMV pneumonitis with review of related literatures.