Cytomegalovirus pneumonitis in heart-lung transplant recipients: histopathology and clinicopathologic considerations.
Three cases of cytomegalovirus (CMV) pneumonitis in heart-lung transplant recipients are presented, and the clinical course and autopsy findings described. The patients survived transplantation for 15, 6, and 2 months, respectively. Cytomegalovirus pneumonitis was diagnosed between 5 and 12 weeks postoperatively, and was still detectable in two of the patients at postmortem examination. In one patient, at autopsy there was no further evidence of CMV pneumonitis 3 months after its onset. Instead we found widespread obliterative bronchiolitis (OB) and signs of acute pulmonary rejection. Early-stage OB was present together with CMV pneumonitis in the patient who had survived transplantation for 2 months. The cause of death in the remaining patient was a bacterial superinfection of the chronic CMV pneumonitis still present more than 1 year after its first manifestation. There were no signs of OB. The marked differences in the clinical course and histologic presentation of CMV pneumonitis in heart-lung transplant recipients and its high, but not uniform, association with OB emphasize the complex interrelations between viral infections and pulmonary rejection.
Fend
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Department of Pathology, Innsbruck University Hospital, Austria.
Prior
C
C
Margreiter
R
R
Mikuz
G
G
D000328:Adult; D001989:Bronchiolitis Obliterans / Q000209:etiology / Q000473:pathology; D003586:Cytomegalovirus Infections / Q000209:etiology / Q000473:pathology*; D006084:Graft Rejection; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D008168:Lung / Q000473:pathology; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D009206:Myocardium / Q000473:pathology; D010496:Pericardium / Q000473:pathology; D011024:Pneumonia, Viral / Q000209:etiology / Q000473:pathology*; D011658:Pulmonary Fibrosis / Q000209:etiology / Q000473:pathology