Abstract
Cytomegalovirus (CMV) pneumonia is an uncommon presentation of CMV among patients with HIV/AIDS, particularly in co-infection with Pneumocystis jirovecii pneumonia (PCP). A case was reported with a literature review, and a comprehensive literature search was performed using the PubMed/MEDLINE and Scopus databases. We report a 52-year-old male with AIDS presenting with progressively worsening dyspnea over 1 week. One month earlier, he had completed a 21-day course of PCP treatment, showed improvement and was discharged. Two weeks before presentation, he started antiretroviral therapy (ART), but his dyspnea worsened significantly 1 week later. Chest radiography showed bilateral ground glass opacities. Bronchoscopy and lung biopsy revealed nuclear enlargement with prominent intranuclear inclusions and marginated chromatin of alveolar cells on H&E staining, along with positive immunohistochemistry for CMV. Grocott’s methenamine silver staining identified 3–5 μm irregular yeast-like organisms resembling crushed ping-pong balls, consistent with P. jirovecii. He was treated with intravenous ganciclovir for a total of 21 days, and his clinical and radiologic findings completely resolved. CMV pneumonia co-infection with PCP is extremely rare and should be considered among patients with severely immunocompromise with interstitial pneumonitis unresponsive to PCP treatment or recurring after treatment.
Get full access to this article
View all access options for this article.