title: When polymerase chain reaction does not help: cytomegalovirus pneumonitis associated with very low or undetectable viral load in both blood and bronchoalveolar lavage samples after lung transplantation.
abstract: Cytomegalovirus (CMV) pneumonitis occurs frequently among solid organ transplant recipients and is classically associated with significant viral replication in both blood and bronchoalveolar lavage (BAL) samples. We present a case of a 64-year-old lung transplant recipient who presented with CMV pneumonitis that was diagnosed based on the association of viral inclusion in the BAL sample, rapid response to ganciclovir, and absence of other infectious etiology. Surprisingly, we observed very low or undetectable viral load both in blood and BAL samples. Diagnosis of CMV pneumonitis should rely on the association of clinical, pathological, radiological, and microbiological signs, while quantitative nucleic acid amplification testing should be interpreted with caution.
authors.affiliation: Department of Infectious Diseases, CHU UCL Namur, Université Catholique de Louvain, Yvoir, Belgium.
authors.forename: J
authors.initials: J
authors.lastname: Coussement
authors.affiliation: Department of Clinical Microbiology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: D
authors.initials: D
authors.lastname: Steensels
authors.affiliation: Department of Pathology, CHU UCL Namur, Université Catholique de Louvain, Yvoir, Belgium.
authors.forename: M-C
authors.initials: MC
authors.lastname: Nollevaux
authors.affiliation: Department of Microbiology, CHU UCL Namur, Université Catholique de Louvain, Yvoir, Belgium.
authors.forename: P
authors.initials: P
authors.lastname: Bogaerts
authors.affiliation: Department of Pneumology and Lung Transplantation, CHU UCL Namur, Université Catholique de Louvain, Yvoir, Belgium.
authors.forename: M
authors.initials: M
authors.lastname: Dumonceaux
authors.affiliation: Department of Infectious Diseases, CHU UCL Namur, Université Catholique de Louvain, Yvoir, Belgium.
authors.forename: B
authors.initials: B
authors.lastname: Delaere
authors.affiliation: Department of Pneumology and Lung Transplantation, CHU UCL Namur, Université Catholique de Louvain, Yvoir, Belgium.
authors.forename: A
authors.initials: A
authors.lastname: Froidure
mesh_terms: D001992:Bronchoalveolar Lavage Fluid / Q000821:virology*; D003587:Cytomegalovirus; D003586:Cytomegalovirus Infections / Q000097:blood / Q000209:etiology*; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D016040:Lung Transplantation / Q000009:adverse effects*; D008875:Middle Aged; D011024:Pneumonia, Viral / Q000097:blood / Q000821:virology*; D016133:Polymerase Chain Reaction; D019562:Viral Load
keywords: cytomegalovirus; lung transplantation; nucleic acid amplification testing; pneumonitis; polymerase chain reaction; viral load