Concurrent Pneumocystis carinii and cytomegalovirus pneumonia after autologous peripheral blood stem cell transplantation

Abstract

Summary:A 46-year-old woman developed concurrent CMV and Pneumocystis carinii pneumonia (PCP) 140 days after autologous peripheral blood stem cell transplantation (APBSCT) for AML. She was seropositive for CMV before undergoing APBSCT and had required prednisone for immune thrombocytopenia and allergic dermatitis for 9 weeks prior to the onset of pneumonia. She had also been receiving PCP prophylaxis with pentamidine aerosol every month for 3 months before developing symptoms. The pneumonia was complicated by severe hypoxia, requiring ventilator support and pneumothorax requiring chest tube thoracostomy. She recovered following treatment with trimethoprim-sulfamethoxazole (TMP-SMX), prednisone, gancyclovir and intravenous immunoglobulin. Although the overall incidence of severe CMV disease is low after APBSCT, preventive measures such as surveillance culture and secondary prophylaxis with gancyclovir may be warranted in patients whose cellular immune response is further compromised by corticosteroid use or other factors.

Cytomegalovirus Pneumonitis Presenting Small Nodular Opacities

“…Only CMV was demonstrated in the present patient, and the administration of gancyclovir was efficacious, leading to the resolution of the lung disease. However, this is not always the case: multiple pathogens have been demonstrated to coinfect (14,15) in immunocompromised patients, thus determination of the causative pathogen has to be prudent. …”

Späte infektiöse Komplikationen nach Hochdosistherapie und autologer Blutstammzelltransplantation

“…vom Patienten irrtümlich unterdosiertes Co-trimoxazol). Hinzuweisen ist auf ein erhöh-tes Risiko nach Kortikosteroidtherapie und sequentieller HDT [7,19,24].…”