Life-threatening pneumonia caused by human cytomegalovirus and Mycoplasma pneumoniae coinfection in a young, immunocompetent patient.
A young, previously healthy and immunocompetent patient was transferred to our hospital to recover a suspected Ascaris worm from his gall bladder. Although the diagnosis of Ascaris infection could not be confirmed, the patient suffered from cholecystitis. To our surprise, the respiratory situation of the patient deteriorated within 24 h under antibiotic therapy and he had to be transferred to the intensive care unit for mechanical respiration. Human cytomegalovirus (HCMV) was isolated directly from a bronchoalveolar lavage (BAL) sample, and Mycoplasma pneumoniae DNA was detected by PCR in an enrichment culture of the same BAL sample. Serology for HCMV and M. pneumoniae clearly supported a primary/post-primary infection for both agents (IgM detection, increase of IgG titres and, in the case of HCMV, a low avidity index of only 22 %). Therefore, we assumed that a rare HCMV and M. pneumoniae coinfection was the aetiology of the fulminant pneumonia. Under broad antibiotic and antiviral treatment, the situation of the patient improved only very slowly.
Jacobi
C A
CA
Department of Internal Medicine I, University Hospital of Tübingen, Otfried-Müller-Straße 10, 72076 Tübingen, Germany.
Riessen
R
R
Medical Intensive Care Unit, University Hospital of Tübingen, Otfried-Müller-Straße 10, 72076 Tübingen, Germany.
Schumacher
U
U
Institute of Medical Microbiology and Hygiene, Elfriede-Aulhorn-Straße 6, 72076 Tübingen, Germany.
Autenrieth
I B
IB
Institute of Medical Microbiology and Hygiene, Elfriede-Aulhorn-Straße 6, 72076 Tübingen, Germany.
Jahn
G
G
Institute of Medical Virology, Elfriede-Aulhorn-Straße 6, 72076 Tübingen, Germany.
Gregor
M
M
Department of Internal Medicine I, University Hospital of Tübingen, Otfried-Müller-Straße 10, 72076 Tübingen, Germany.
Raible
A
A
Department of Internal Medicine I, University Hospital of Tübingen, Otfried-Müller-Straße 10, 72076 Tübingen, Germany.
Hamprecht
K
K
Institute of Medical Virology, Elfriede-Aulhorn-Straße 6, 72076 Tübingen, Germany.
D000328:Adult; D000907:Antibodies, Bacterial / Q000097:blood; D000914:Antibodies, Viral / Q000097:blood; D000915:Antibody Affinity; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology / Q000821:virology; D003587:Cytomegalovirus / Q000302:isolation & purification*; D003586:Cytomegalovirus Infections / Q000150:complications* / Q000175:diagnosis / Q000821:virology; D004269:DNA, Bacterial / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D008297:Male; D009177:Mycoplasma pneumoniae / Q000302:isolation & purification*; D011019:Pneumonia, Mycoplasma / Q000150:complications* / Q000175:diagnosis* / Q000382:microbiology; D011024:Pneumonia, Viral / Q000150:complications* / Q000175:diagnosis* / Q000821:virology; D013902:Radiography, Thoracic; D014054:Tomography
D000907:Antibodies, Bacterial; D000914:Antibodies, Viral; D004269:DNA, Bacterial; D007074:Immunoglobulin G; D007075:Immunoglobulin M