Cytomegalovirus Pneumonia in a Patient with Down Syndrome

Abstract

Down syndrome (DS) is a chromosomal disorder due to the presence of an additional chromosome 21 that causes intellectual deficit and physical anomalies and predisposes patients to develop infections throughout their lives. Pneumonias are more serious in patients with DS, requiring hospitalization, and they represent an important cause of mortality in this population. Cytomegalovirus (CMV) causes widespread and serious infections in immunocompromised individuals, affecting the respiratory tract and, when causing interstitial pneumonia, associated with a high mortality rate. However, CMV-induced pneumonia is not reported in DS patients. The prevalence and severity of CMV respiratory infections in subjects with DS is unknown. This case describes a 50-year-old female patient with DS who developed extensive bilateral pneumonia with severe respiratory failure which required hospitalization in intensive care, intubation, and mechanical ventilation after approximately 10 days of empiric antibiotic and anitimycotic therapy for fever, cough, and dyspnea. The patient was diagnosed with CMV pneumonia and recovered after treatment with ganciclovir. To the best of our knowledge, this is the first reported case of CMV pneumonia in a patient with DS. This case aims to highlight that CMV pneumonia in individuals with DS can be a life-threatening condition. It also clarifies the importance of early diagnosis of infections from opportunistic pathogens such as CMV to ensure timely and efficient treatment.

Keywords: Down syndrome; cytomegalovirus; pneumonia.

Figure 1

Chest X-ray upon admission to hospital shows bilateral pneumonia, with greater involvement of the right lung. SUPINO: supine; SIN: left.

Figure 2

Chest CT showing extensive parenchymal thickening of the entire right lung and subtotal consolidation of the left lung.

Figure 3

Chest X-ray 48 h after starting ganciclovir therapy shows an improvement in pulmonary densifications, more evident in the left lung.

Figure 4

Chest X-ray of the patient extubated after 10 days of ganciclovir therapy shows almost complete resolution of bilateral interstitial pneumonia. SUPINO: supine; SIN: left.