Generalized Cytomegalic Inclusion-Body Disease Associated With Pneumocystis Pneumonia in Adults

Abstract

Three cases of generalized cytomegalic inclusion-body disease (salivary virus disease) in adults are reported, bringing the number of published cases up to 34. The infection is very rare in adults although well known in infants. As is often found in infants with this disease, pneumonia due toPneumocystis cariniiwas also present in each case.The first patient had Wegener's granulomatosis, which presented with acute otitis media: a review of histological material obtained at mastoidectomy eight weeks before death showed that inclusion-body cytomegaly was already present then. Various antibiotics and prednisolone were given, and the lesions in the respiratory organs and the arteritis healed to a considerable extent. Renal failure, however, was progressive and led to death.The second patient had thrombotic purpura and died after a few weeks' illness, during which oxytetracycline and hydrocortisone were given. Congenital absence of the spleen was found at laparotomy, which was performed with the object of doing a splenectomy. Focal cryptococcal pneumonia was presentpost mortem: six years before death a solitary cryptococcal granuloma of one lung had been treated by lobectomy.The third patient had had Hodgkin's disease for 18 years. During the first 12 years the disease had the characteristics of the so-called indolent form (“Hodgkin's paragranuloma”) and it then passed into the typical form. Deepx-ray therapy and cytotoxic drugs were used during the course of the disease at various times, and streptomycin and tuberculostatic drugs were given because of intercurrent tuberculous meningitis which developed three months before death.In all three cases it seems likely that the underlying disease, or the drugs used in its treatment, predisposed to cytomegalic inclusion-body disease and concomitant pneumocystis pneumonia by lowering the patients' resistance. Just as some unusual types of fungal and bacterial infections have become less rare since the introduction of certain drugs, including antibiotics and steroids, it is possible that cytomegalic inclusion-body disease and pneumocystis infection may also be met with oftener in adults, perhaps particularly as a complication of the use of these drugs in the treatment of diseases which are specially liable to interfere with the body's defences.

Trends in the Epidemiology of Pneumocystis Pneumonia in Immunocompromised Patients without HIV Infection

“…Cancers are one of the earliest identified underlying conditions associated with PCP, as first reported in late 1950s in patients with leukemia and Hodgkin’s disease [ 91 , 92 ]. Hematological malignancies (including various leukaemias and lymphomas as well as multiple myeloma) remain the most common underlying diseases predisposing patients to PCP, accounting for ~30–80% of PCP cases among non-HIV patients [ 10 , 29 , 31 ].…”

“…GPA is a rare necrotizing vasculitis characterized by necrotizing granulomas and pauci-immune vasculitis that most commonly affects small- to medium-sized vessels in the respiratory tract and kidneys. The first case of PCP associated with GPA was reported in 1960 from a female American adult [ 92 ]. Based on multiple systematic reviews of data reported worldwide, GPA appears to be the most common AIID associated with PCP, with an estimated incidence of 6–20% [ 32 , 144 , 145 ].…”

Cytomegalic Inclusion Body Disease (An Example of a Common Infection Causing a Rare Disease)

“…In these cases diagnosis during life is virtually impossible ( 6 ). Two forms occur, local or disseminated, but both appear to be associated with severe debilitating conditions which themselves are usually fatal.…”

Pathological observations on experimental cytomegalovirus infections in pregnancy

“…However, cytomegalovirus infection in a pregnant woman may also be associated with haematological changes and lesions in her lungs, kidneys, salivary and adrenal glands and spleen (Symmers, 1960;Plummer, 1973). Thus abortion, congenital deformity or foetal growth retardation in human babies may be mediated by any of three mechanisms, namely: 1.…”