Case report
Cytomegalovirus pneumonia in immunocompetent host: Case report and literature review

https://doi.org/10.1016/j.jcv.2012.08.010Get rights and content

Abstract

CMV infection is highly prevalent in general population and its clinical picture generally ranges from asymptomatic disease to mononucleosis-like syndrome. While severe life-threatening CMV disease is well documented in certain immunocompromised risk groups, severe infection with symptomatic pneumonia in immunocompetent hosts has been rarely documented.

In this paper we describe a case of primary CMV infection, complicated by severe CMV pneumonia in an immunocompetent host, successfully treated with oral valganciclovir. Moreover, we reviewed CMV pneumonia cases in immunocompetent adults reported in the literature.

Section snippets

Why this case is important?

Cytomegalovirus (CMV) infection is common throughout the world: 40–100% of adults become infected by the fourth decade of life.1, 2 Although primary infection in immunocompetent individuals is usually subclinical, a mononucleosis-like syndrome characterized by malaise, fever, abnormalities of liver function and lymphocytosis occurs in 10% of the patients.3, 4

The spectrum of illness caused by CMV is well documented in certain immunocompromised risk groups (transplant recipients, patients with

Case description

On November 2010, a nonsmoker 29-year old man complaining with high fever, chills, headache and malaise for two weeks, was admitted to our hospital. He had no significant individual or familiar medical history.

On admission his body temperature was 38.5 °C, with a pulse rate of 110 beats/min, and a respiratory rate of 24 breaths/min. His physical examination revealed laterocervical lymphoadenopathy, pharyngitis and a harsher vesicular breath sound on auscultation.

Blood exams at admission showed:

Other similar and contrasting cases in the literature

We performed a Pubmed search of the literature for articles in English describing CMV pneumonia in immunocompetent adult patients, using the following mesh terms: CMV, pneumonia, and immunocompetent. From the references of these papers, we obtained further relevant articles.

We found 13 cases of CMV pneumonia in immmunocompetent patients, as shown in Table 1. Nine of these cases were reported by Eddleston et al.6 in his review describing 34 cases of severe CMV infection.

Vogel13 described a case

Discussion

CMV pneumonia in the immunocompetent often presents as severe viral pneumonia,8, 9 with diffuse interstitial infiltrates on chest X-ray and respiratory failure7, 25, 26, 27, 28, 29, 30; occasionally the radiological picture is limited to one lobe or may reveal focal infiltrates.22

The laboratory diagnosis may be based on serological tests or pathological features. The serological diagnosis is essentially based on elevated CMV IgM antibodies titer, or on increasing titer of IgG antibodies.

Authors’ contribution

E.G. and V.G. have made substantial contributions to description of the case report and to the review of the literature. F.T. and L.B. have been involved in drafting the manuscript. N.P. reviewed the manuscript. L.B. performed virological assays.

Funding

None.

Competing interests

The authors declare that they have no competing interests.

Ethical approval

The patient gave his written consent for the clinical case report.

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