Primary Cytomegalovirus-Related Eosinophilic Pneumonia in a Three-year-old Child with Acute Lymphoblastic Leukaemia: Case report and literature review

Abstract

A diagnosis of eosinophilic pneumonia (EP) is rare in patients with acute lymphoblastic leukaemia (ALL). We report a case of EP in association with a primary cytomegalovirus (CMV) infection in a three-year-old Omani child with ALL. The patient presented with fever while undergoing maintenance chemotherapy. He was admitted to the Child Health Department of Royal Hospital, in Muscat, Oman, in November 2011. He was initially thought to have sepsis but failed to respond to antibiotics. Chest computed tomography showed diffuse ground glass lung opacification. Bronchoalveolar lavage (BAL) cytology was consistent with the diagnosis of EP. Polymerase chain reaction tests for CMV were performed on the BAL and blood samples and were both markedly elevated. The patient made a full recovery after treatment with prednisolone and ganciclovir. The association between CMV infection and EP as well as the management of this combination in immunocompromised patients has never been reported in the English literature.

Keywords: Bronchoalveolar Lavage; Case Report; Cytomegalovirus; Eosinophilic Pneumonia; Immuno-compromised Patients; Lymphocytic Leukemia; Oman.

Figure 1:

Chest X-ray showing poor inspiratory film, with a suspicious bilateral mild diffuse air-space consolidation (black arrows). R = right side; AP = anterior-posterior view.

Figure 2:

Axial computed tomography image through the lower lobes of the lungs in the lung window, showing areas of diffuse ground glass appearance in both lungs (arrows).