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Case Reports
. 2017:2017:9314580.
doi: 10.1155/2017/9314580. Epub 2017 Sep 18.

Immune Reconstitution Inflammatory Syndrome and Cytomegalovirus Pneumonia Case Report: Highlights and Missing Links in Classification Criteria and Standardized Treatment

Stefania Petarra-Del Río  1 , Adrian Rodriguez-Hernandez  2 , Luis Anguiano-Landa  3 , Georgina Aguilar-Portillo  1 , Isidro Zavala-Trujillo  2 , Arnulfo Hernan Nava-Zavala  1   4 , Maria G Zavala-Cerna  1
Affiliations
Case Reports

Immune Reconstitution Inflammatory Syndrome and Cytomegalovirus Pneumonia Case Report: Highlights and Missing Links in Classification Criteria and Standardized Treatment

Stefania Petarra-Del Río et al. Case Rep Infect Dis. 2017.

Abstract

Background: Cytomegalovirus (CMV) pulmonary involvement is rarely associated with IRIS; therefore, limited information is available.

Case presentation: Here, we describe the case of a 43-year-old HIV-infected male who developed an unusual case of IRIS after cytomegalovirus (CMV) pneumonia. Clinically there was a progressive and paradoxical worsening of respiratory distress, despite being treated for CMV after initiation with antiretroviral therapy. Chest X-ray revealed disseminated infiltrates in both lungs; chest CT-scan showed generalized lung involvement and mediastinal adenopathy. Pulmonary biopsy confirmed CMV pneumonia with the observation of typical viral inclusions on pneumocytes.

Conclusions: CMV pneumonia can be associated with the development of IRIS requiring treatment with immunosuppressant's and immunomodulatory drugs.

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Figures

Figure 1
Figure 1
Pulmonary CT-scan with evidence of atypical bilateral pneumonia: pulmonary parenchyma with multiple areas of interstitial infiltrates (patchy infiltrates) involving apical and medial areas of both pulmonary fields.
Figure 2
Figure 2
Panel (a): lung biopsy with pulmonary tissue showing young fibroblast proliferation at the interstitial level with lymphocytes, histiocytes, and red blood cells. Panel (b): abundant cytomegalovirus inclusions and alveolar spaces with type II pneumocytes and red blood cells. Ziehl-Neelsen, Grocott, and periodic acid-Schiff stain (PAS) were negative. Panel (c): esophagus biopsy with loss of mucosal continuity and the presence of hemorrhage. Panel (d): important infiltration of polymorphonuclear cells and epithelioid cells with a few fragments of squamous epithelia. Acid fast bacilli stain and fungal stains were negative.
Figure 3
Figure 3
Timeline of patients' clinical evolution with diagnostic tests and treatments. HIV human immunodeficiency virus, KS Kaposi's sarcoma, PPD purified protein derivative, CMV cytomegalovirus, ART antiretroviral therapy, CPAP continuous positive airway pressure, and IRIS immune reconstitution inflammatory syndrome.
See this image and copyright information in PMC

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