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Katagiri A, Ando T, Kon T, Yamada M, Iida N, Takasaki Y. Cavitary lung lesion in a patient with systemic lupus erythematosus: an unusual manifestation of cytomegalovirus pneumonitis. Mod Rheumatol 2014. [DOI: 10.3109/s10165-008-0039-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Katagiri A, Ando T, Kon T, Yamada M, Iida N, Takasaki Y. Cavitary lung lesion in a patient with systemic lupus erythematosus: an unusual manifestation of cytomegalovirus pneumonitis. Mod Rheumatol 2008; 18:285-9. [DOI: 10.1007/s10165-008-0039-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2007] [Accepted: 12/03/2007] [Indexed: 10/22/2022]
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Allen TC, Bag R, Zander DS, Cagle PT. Cytomegalovirus Infection Masquerading as Carcinoma in a Lung Transplant Patient. Arch Pathol Lab Med 2005; 129:e1-3. [DOI: 10.5858/2005-129-e1-cimaci] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
In lung transplant patients, most infections produce radiographically diffuse or lobar infiltrates. Solitary nodules suggesting neoplasm may arise in lung transplant patients with lung infections. We describe a 45-year-old woman who underwent bilateral lung transplantation to treat bilateral bronchiectasis and lung fibrosis resulting from Hodgkin disease. Five months later, a solitary mass was identified on chest radiograph in the left upper lobe and left superior mediastinum. Low-power examination of wedge biopsies of the mass showed a florid proliferation of cells with clear to bubbly to eosinophilic cytoplasm and moderate nuclear atypia, proliferating fibroblasts, and necrosis, suggesting a clear cell carcinoma (possibly metastatic renal cell carcinoma). Intranuclear inclusions compatible with cytomegalovirus were identified on high-power examination and confirmed by immunohistochemistry. In lung transplant patients, a cytomegalovirus infection may mimic malignancy both radiographically and on initial histopathologic examination.
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Affiliation(s)
- Timothy Craig Allen
- From the Department of Pathology, University of Texas Health Center, Tyler (Dr Allen); the Departments of Medicine–Pulmonary (Dr Bag) and Pathology (Dr Cagle), Baylor College of Medicine, Houston, Tex; and the Department of Pathology, University of Texas Health Science Center, Houston Medical School, Houston, Tex (Dr Zander). Dr Cagle is now with the Department of Pathology, The Methodist Hospita
| | - Remzi Bag
- From the Department of Pathology, University of Texas Health Center, Tyler (Dr Allen); the Departments of Medicine–Pulmonary (Dr Bag) and Pathology (Dr Cagle), Baylor College of Medicine, Houston, Tex; and the Department of Pathology, University of Texas Health Science Center, Houston Medical School, Houston, Tex (Dr Zander). Dr Cagle is now with the Department of Pathology, The Methodist Hospita
| | - Dani S. Zander
- From the Department of Pathology, University of Texas Health Center, Tyler (Dr Allen); the Departments of Medicine–Pulmonary (Dr Bag) and Pathology (Dr Cagle), Baylor College of Medicine, Houston, Tex; and the Department of Pathology, University of Texas Health Science Center, Houston Medical School, Houston, Tex (Dr Zander). Dr Cagle is now with the Department of Pathology, The Methodist Hospita
| | - Philip T. Cagle
- From the Department of Pathology, University of Texas Health Center, Tyler (Dr Allen); the Departments of Medicine–Pulmonary (Dr Bag) and Pathology (Dr Cagle), Baylor College of Medicine, Houston, Tex; and the Department of Pathology, University of Texas Health Science Center, Houston Medical School, Houston, Tex (Dr Zander). Dr Cagle is now with the Department of Pathology, The Methodist Hospita
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Lee P, Minai OA, Mehta AC, DeCamp MM, Murthy S. Pulmonary nodules in lung transplant recipients: etiology and outcome. Chest 2004; 125:165-72. [PMID: 14718437 DOI: 10.1378/chest.125.1.165] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The pulmonary nodule (PN) poses a diagnostic and therapeutic challenge in the immunocompromised host. Common causes of PNs in lung transplant (LT) recipients include bacterial or fungal infections and posttransplant lymphoproliferative disorder (PTLD). However, experience in diagnosis and management of PNs is limited. METHODS Two hundred thirty-four LTs were performed between February 1990 and December 2000. Medical records of all patients with PNs were reviewed retrospectively. Data on presentation, radiographic features, diagnostic methods, therapy, and outcome were collected and analyzed. RESULTS Twenty-three patients had PNs after a follow-up of 20.1 +/- 20.1 months (mean +/- SD). The mean age was 45.5 +/- 14.4 years, with a male:female ratio of 17:6. Thirteen patients received single LT, 9 patients received bilateral LT, and 1 patient received heart-LT. Cough and dyspnea were the most common symptoms at presentation, and PNs were better detected by CT than chest radiography. Solitary PNs were due to bronchogenic carcinoma and PTLD, while multiple PNs were due to invasive pulmonary aspergillosis (IPA), cytomegalovirus pneumonitis, bronchiolitis obliterans, and metastatic carcinoma. Bronchoscopy with BAL and transbronchial lung biopsy was the usual method of diagnosis (n = 17, 74%), and our mortality rate was 70%. CONCLUSION PNs are not uncommon in patients following LT. The majority were due to IPA and PTLD. Prophylaxis with itraconazole against Aspergillus, and acyclovir for Epstein-Barr virus-negative LT recipients, serial CT and surveillance bronchoscopy for early detection of Aspergillus infections, and rituximab therapy for PTLD could improve the outcome of these patients.
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Affiliation(s)
- Pyng Lee
- Department of Respiratory Medicine and Critical Care Medicine, Singapore General Hospital, Singapore
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Vidal JE, Dauar RF, Penalva de Oliveira AC, Coelho JFGS, Lins DLM. Cerebral mass lesion due to cytomegalovirus in a patient with AIDS: case report and literature review. Rev Inst Med Trop Sao Paulo 2003; 45:333-7. [PMID: 14762635 DOI: 10.1590/s0036-46652003000600007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Cytomegalovirus (CMV) disease in acquired immunodeficiency syndrome (AIDS) patients most commonly presents as chorioretinitis and gastro-intestinal infection. Neurological involvement due to CMV may cause several clinical presentations: polyradiculitis, myelitis, encephalitis, ventriculo-encephalitis, and mononeuritis multiplex. Rarely, cerebral mass lesion is described. We report a 39 year-old woman with AIDS and previous cerebral toxoplasmosis. She presented with fever, seizures, and vulval ulcers. Her chest X-ray showed multiple lung nodules, and a large frontal lobe lesion was seen in a brain computed tomography scan. She underwent a brain biopsy through a frontal craniotomy, but her condition deteriorated and she died in the first postoperative day. Histopathological studies and immunohistochemistry disclosed CMV disease, and there was no evidence of cerebral toxoplasmosis, bacterial, mycobacterial or fungal infection. CMV disease should be considered in the differential diagnosis of cerebral mass lesion in AIDS patients. High suspicion index, timely diagnostic procedures (surgical or minimally invasive), and proper utilization of prophylactic and therapeutic medication could improve outcome of these patients.
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Affiliation(s)
- José E Vidal
- Instituto de Infectologia Emílio Ribas, São Paulo, SP, Brazil.
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Karakelides H, Aubry MC, Ryu JH. Cytomegalovirus pneumonia mimicking lung cancer in an immunocompetent host. Mayo Clin Proc 2003; 78:488-90. [PMID: 12683701 DOI: 10.4065/78.4.488] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Cytomegalovirus (CMV) pneumonia can be a life-threatening disease in immunocompromised patients such as transplant recipients and patients given immunosuppressive therapy. Although CMV infections are highly prevalent in the general population, symptomatic pneumonia in an immunocompetent adult has been documented rarely. We describe a 47-year-old male smoker who presented with a 3.5-cm cavitary mass in the upper lobe of the left lung, highly suggestive of lung cancer. Wedge resection of the mass on thoracotomy revealed CMV pneumonia with no evidence of malignancy or other infections. No antiviral therapy was given to this immunocompetent patient, and no additional manifestations of CMV disease occurred.
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Affiliation(s)
- Helen Karakelides
- Department of Internal Medicine, Mayo Clinic, Rochester, Minn 55905, USA
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Moon JH, Kim EA, Lee KS, Kim TS, Jung KJ, Song JH. Cytomegalovirus pneumonia: high-resolution CT findings in ten non-AIDS immunocompromised patients. Korean J Radiol 2000; 1:73-8. [PMID: 11752933 PMCID: PMC2718167 DOI: 10.3348/kjr.2000.1.2.73] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To describe the HRCT findings of cytomegalovirus (CMV) pneumonia in non-AIDS immunocompromised patients MATERIALS AND METHODS This retrospective study involved the ten all non-AIDS immunocompromised patients with biopsy-proven CMV pneumonia and without other pulmonary infection encountered at our Medical Center between January 1997 and May 1999. HRCT scans were retrospectively analysed by two chest radiologists and decisions regarding the findings were reached by consensus. RESULTS The most frequent CT pattern was ground-glass opacity, seen in all patients, with bilateral patchy (n = 8) and diffuse (n = 2) distribution. Other findings included poorly-defined small nodules (n = 9) and consolidation (n = 7). There was no zonal predominance. The small nodules, bilateral in eight cases and unilateral in one, were all located in the centrilobular region. Consolidation (n = 7), with patchy distribution, was bilateral in five of seven patients (71%). Pleural effusion and bilateral areas of thickened interlobular septa were seen in six patients (60%). CONCLUSION CMV pneumonia in non-AIDS immunocompromised patients appears on HRCT scans as bilateral mixed areas of ground-glass opacity, poorly defined centrilobular small nodules, and consolidation. Interlobular septal thickening and pleural effusion are frequently associated.
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Affiliation(s)
- J H Moon
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Brown MA, Nadler JP. Infections in HIV-Infected Patients With Malignancy. Cancer Control 1996; 3:544-551. [PMID: 10764515 DOI: 10.1177/107327489600300611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- MA Brown
- Division of Infectious Diseases and Tropical Medicine, University of South Florida, Tampa 33612, USA
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Abstract
With the increasing prevalence of HIV, better combination treatment regimens, and preventive therapy for opportunistic infections, physicians will be caring for an ever-increasing number of survivors with an ever-dwindling immune function. Increasing this burden is the unfortunate patient who also develops cancer concurrent with HIV infection. The combined risk factors of these diseases make a worst-case scenario in evaluation and treatment of infections. This article reviews AIDS-defining tumors and other malignancies, risk factors for infection, opportunistic infections, and therapy strategies.
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Affiliation(s)
- M A Brown
- Division of Infectious Diseases and Tropical Medicine, University of South Florida, Tampa, USA
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End A, Helbich T, Wisser W, Dekan G, Klepetko W. The pulmonary nodule after lung transplantation. Cause and outcome. Chest 1995; 107:1317-22. [PMID: 7750325 DOI: 10.1378/chest.107.5.1317] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
In the immunocompromised patient, the pulmonary nodule remains a diagnostic and therapeutic challenge. We studied the incidence, cause, diagnosis, and therapy of pulmonary nodules after lung transplantation (LTx). Eight out of 64 patients (12.5%) developed pulmonary nodules after a median follow-up of 5.8 months (range, 1 to 10 months). The median age was 30.5 years (range, 21 to 62 years). Solitary pulmonary nodules (n = 2) disappeared spontaneously within 3 weeks and were suspected to be of infectious origin. The cause of multiple nodules (n = 6) was posttransplant lymphoproliferative disorder (PTLD [n = 3]), aspergillosis (n = 2), and abscesses caused by Pseudomonas aeruginosa and Staphylococcus aureus (n = 1). After an initial chest radiograph, CT with fine-needle biopsy was the most valuable diagnostic tool. In six patients, nodules resolved within 10 weeks (median, 8 weeks). Two patients, however, died of sepsis (P aeruginosa and S aureus and Aspergillus, respectively). The differential diagnosis of pulmonary nodules after LTx primarily comprises PTLD and infection (bacterial or fungal). To improve the outcome, early, aggressive treatment is mandatory; therefore, serial CT scans are strongly recommended to be part of the diagnostic armamentarium in LTx recipients.
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Affiliation(s)
- A End
- Department of Surgery, University of Vienna, Austria
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Abstract
Human cytomegalovirus (HCMV) can establish lifelong persistence after primary infection with reactivation occurring as a result of immunosuppression. There is much evidence that molecular interactions between the immune system and the HCMV are responsible for immune escape. HCMV in many cells especially in mononuclear blood cells during latency are frequently the source of transmission and spreading and results in a variety of disorders. In this review some data about acute infection in immunocompetent host (mononucleosis, hepatitis), about intrauterine HCMV infection, about infection and endogenous reinfection in bone marrow and solid organ transplant recipients (pneumonitis) and about HCMV disease in AIDS patients (encephalitis, neuropathy, retinitis, colitis) are investigated. Moreover, HCMV associated vasculitis is described in patients with myocarditis, rheumatoid arthritis or polyradiculopathy. HCMV could play an important role in atherosclerosis. Several types of human malignancy have been linked to HCMV and it has been shown that HCMV ie genes upregulate expression of cellular oncogenes. The diagnosis of HCMV infection is carried out by viremia in cell culture using immediate early antigen staining, by antigenaemia which appears to be an early quantitative and predictive tool, by HCMV DNA detection using hybridization and PCR, and by IgM and IgG antibody evaluation. Two antiviral drugs are used for treatment: ganciclovir and phosphonoformic acid; few resistant clinical isolates have been reported. Specific gammaglobulin activity is discussed. HCMV vaccine is not available.
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Affiliation(s)
- P Wattré
- Laboratoire de bactériologie-virologie B, CHRU, bätiments IRFPPS, Lille, France
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Lewin SR, Hoy J, Crowe SM, McDonald CF. The role of bronchoscopy in the diagnosis and treatment of pulmonary disease in HIV-infected patients. AUSTRALIAN AND NEW ZEALAND JOURNAL OF MEDICINE 1995; 25:133-9. [PMID: 7605295 DOI: 10.1111/j.1445-5994.1995.tb02825.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Pulmonary disease is the most common reason for presentation and the major cause of death in HIV-infected patients. There has been an evolution in the optimal approach to the investigation of a pulmonary infiltrate in HIV-infected patients since the introduction of induced sputum for the diagnosis of Pneumocystis carinii pneumonia (PCP). AIMS To evaluate the usefulness of flexible fibreoptic bronchoscopy (FFB), bronchoalveolar lavage (BAL), transbronchial biopsy (TBB) and bronchial brushings (BB) in the diagnosis of pulmonary disease in HIV-infected patients and to examine the effect of FFB on changes in therapy and survival. METHODS The histories of all HIV-infected patients referred to Fairfield Hospital for FFB between January 1990 and June 1993 were examined retrospectively. RESULTS Forty-two FFB were performed on 41 patients (40 male and one female). Definitive diagnoses made at FFB included Kaposi's sarcoma (KS) (n = 9), invasive aspergillosis (n = 5), PCP (n = 4), Mycobacterium avium complex (MAC) pneumonia (n = 2), cytomegalovirus (CMV) pneumonia (n = 1), Cryptococcus neoformans pneumonia (n = 1), microsporidium (n = 1) and Pseudomonas aeruginosa pneumonia (n = 1). TBB and BB did not provide a diagnosis for diseases not seen macroscopically at FFB or diagnosed by BAL. FFB findings altered diagnosis in 21/42 (50%) presentations and changed therapy in 26/42 (62%) cases. CONCLUSIONS FFB together with BAL altered the working diagnosis and changed therapy in a significant number of patients. TBB and BB should not be routinely performed in all patients as these procedures are of limited value in this setting.
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Jain NK, Lie TH. Fever, multiple pulmonary nodules, and ulcerated skin lesions in a patient with AIDS. Chest 1995; 107:553-5. [PMID: 7842793 DOI: 10.1378/chest.107.2.553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- N K Jain
- Respiratory Diseases Section, VAMC, Bay Pines, Florida
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