Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
권호 표지

A Case of Diffuse Alveolar Hemorrhage Associated with Cytomegalovirus Pneumonia

거대세포바이러스 폐렴에 동반된 미만성 폐포출혈 1예

  • Cho, Yong Duck (Department of Pulmonary, Allergy and Critical Care Medicine, Kyung Hee University School of Medicine) ;
  • Choi, Hye Sook (Department of Pulmonary and Critical Care Medicine, Dongguk University College of Medicine) ;
  • Park, Myung Jae (Department of Pulmonary, Allergy and Critical Care Medicine, Kyung Hee University School of Medicine)
  • 조용덕 (경희대학교 의과대학 호흡기내과학교실) ;
  • 최혜숙 (동국대학교 의과대학 호흡기내과학교실) ;
  • 박명재 (경희대학교 의과대학 호흡기내과학교실)
  • Received : 2008.03.12
  • Accepted : 2008.03.31
  • Published : 2008.04.30
Download PDF
⟨ Previous Next ⟩

Abstract

Cytomegalovirus (CMV) pneumonia is a serious opportunistic infection in an immunocompromised host such as an AIDS patient or transplant recipient undergoing immunosuppressive therapy. Diffuse alveolar hemorrhage (DAH) is a relatively uncommon condition and it occurs most often in patients with systemic autoimmune disease. However, various types of infectious pneumonia with Mycoplsma hominis, Stenotrophomonas maltophilia and Pneumocystis jirovecii have been reported to be associated with the development of DAH. The association of CMV infection with the development of DAH has rarely been reported. We experienced a case of DAH associated CMV pneumonia and the patient was successfully treated with the use of antiviral agents and steroids.

미만성 폐포출혈은 흔히 교원성질환에 동반되어 발생하나 거대세포바이러스 폐렴과 동반되어 나타날 수 있으며 병인은 아직 밝혀지지 않았다. 따라서 이 두 질환의 연관관계에 대한 연구가 필요하다. 저자들은 뇌출혈로 입원 후 장기간 치료 중이던 환자에서 거대세포바이러스 폐렴과 이에 동반된 미만성 폐포출혈 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

Keywords

References

  1. Riddell SR. Pathogenesis of cytomegalovirus pneumonia in immunocompromised hosts. Semin Respir Infect 1995;10:199-208
  2. Ham HS, No GH, Kang EH, Kang SJ, An CH, Suh GY, et al. The clinical characteristics of diffuse alveolar hemorrhage: a retrospective study of 21 cases. Tuberc Respir Dis 2000;49:614-23 https://doi.org/10.4046/trd.2000.49.5.614
  3. De Lassence A, Fleury-Feith J, Escudier E, Beaune J, Bernaudin JF, Cordonnier C. Alveolar hemorrhage. Diagnostic criteria and results in 194 immunocompromised hosts. Am J Respir Crit Care Med 1995;151:157-63 https://doi.org/10.1164/ajrccm.151.1.7812547
  4. Vincent B, Flahault A, Antoine M, Wislez M, Parrot A, Mayaud C, et al. AIDS-related alveolar hemorrhage: a prospective study of 273 BAL procedures. Chest 2001; 120:1078-84 https://doi.org/10.1378/chest.120.4.1078
  5. Kane JR, Shenep JL, Krance RA, Hurwitz CA. Diffuse alveolar hemorrhage associated with Mycoplasma hominis respiratory tract infection in a bone marrow transplant recipient. Chest 1994;105:1891-2 https://doi.org/10.1378/chest.105.6.1891
  6. Ortin X, Jaen-Martinez J, Rodriguez-Luaces M, Alvaro T, Font L. Fatal pulmonary hemorrhage in a patient with myelodysplastic syndrome and fulminant pneumonia caused by Stenotrophomonas maltophilia. Infection 2007;35:201-2 https://doi.org/10.1007/s15010-007-6042-y
  7. Heo WY, Jung WJ, Lee YJ, Park SD, Lee SW, Park MJ, et al. A case of pneumocystis carinii pneumonia with diffuse pulmonary hemorrhage. Tuberc Respir Dis 2004;57:372-6 https://doi.org/10.4046/trd.2004.57.4.372
  8. Tsushima K, Koyama S, Takematsu H, Okada K, Hata S, Ichiyoshi T, et al. Massive pulmonary hemorrhage due to cytomegalovirus infection in a Japanese patient with alpha-1-antitrypsin-deficient emphysema. Respiration 1999;66:373-6 https://doi.org/10.1159/000029393
  9. Herry I, Cadranel J, Antoine M, Meharzi J, Michelson S, Parrot A, et al. Cytomegalovirus-induced alveolar hemorrhage in patients with AIDS: a new clinical entity? Clin Infect Dis 1996;22:616-20 https://doi.org/10.1093/clinids/22.4.616
  10. Shin HJ, Kim HK, Kim HS. The usefulness of PCR and early antigen immunostaining as a rapid identification method of cytomegalovirus infection. Kor J Clin Pathol 1998;18:452-7
  11. Meyers JD, Flournoy N, Thomas ED. Risk factors for cytomegalovirus infection after human marrow transplantation. J Infect Dis 1986;153:478-88 https://doi.org/10.1093/infdis/153.3.478
  12. Kahn FW, Jones JM, England DM. Diagnosis of pulmonary hemorrhage in the immunocompromised host. Am Rev Respir Dis 1987;136:155-60 https://doi.org/10.1164/ajrccm/136.1.155
  13. Magro CM, Crowson AN, Ferri C. Cytomegalovirus-associated cutaneous vasculopathy and scleroderma sans inclusion body change. Hum Pathol 2007;38:42-9 https://doi.org/10.1016/j.humpath.2006.06.002
  14. Magro C, Ali N, Williams JD, Allen JN, Ross P Jr. Cytomegalovirus-associated pulmonary septal capillary injury sine inclusion body change: a distinctive cause of occult or macroscopic pulmonary hemorrhage in the immunocompetent host. Appl Immunohistochem Mol Morphol 2005;13:268-72 https://doi.org/10.1097/01.pai.0000137911.39736.95
  15. Chang WI, Oh JH, Han HW, Kim SH, Kim YS, Son SH, et al. Fatal cytomegalovirus pneumonia in a immunocompetent patient. Korean J Infect Dis 2000;32:78-81