PDF(Pubmed)
Abstract：
Cytomegalovirus (CMV) infection is one of the most common infectious complications following hematopoietic stem cell transplantation (HSCT); however, cases involving multiple organs at the same time are rare. The present study describes a case of CMV pneumonia combined with CMV DNAemia and CMV cystitis after HSCT. A 33-year-old male patient with acute myeloid leukemia was treated with HSCT. The first month after HSCT, the patient developed a cough and shortness of breath. At 2 months post-HSCT, the patient developed hematuria. The CMV DNA levels in the blood and urine were elevated; bronchoalveolar lavage fluid (BALF) was also positive for CMV DNA. Heterotypic cells exhibiting a large nuclear morphology were observed in the BALF and bronchial brushes. Recurrent and progressive ground-glass opacities were evident on chest computed tomography. The patient was diagnosed with CMV pneumonia complicated by CMV DNAemia and CMV cystitis, and was treated with a combination of ganciclovir and foscarnet, along with immunoglobulin therapy. The patient was cured and discharged. It was determined that the CMV DNA in the blood was inconsistent with that in the BALF, which delayed the early diagnosis of CMV pneumonia. The association between T-cell immune function and the therapeutic efficacy for CMV multi-organ infection following HSCT is known to be significant. Moreover, the timely administration of ganciclovir and foscarnet in combination with immunoglobulin therapy demonstrated favorable clinical outcomes.
摘要：
巨细胞病毒(CMV)感染是造血干细胞移植(HSCT)后最常见的感染性并发症之一;同时涉及多个器官的病例很少见。本研究描述了HSCT后CMV肺炎合并CMVDNA血症和CMV膀胱炎的病例。一名33岁的男性急性髓系白血病患者接受了HSCT治疗。HSCT后的第一个月，病人出现咳嗽和呼吸急促。在HSCT后2个月，患者出现血尿。血液和尿液中的CMVDNA水平升高；支气管肺泡灌洗液（BALF）对CMVDNA也呈阳性。在BALF和支气管刷中观察到表现出大核形态的异型细胞。在胸部计算机断层扫描上明显出现复发性和进行性毛玻璃混浊。患者被诊断为CMV肺炎并发CMVDNA血症和CMV膀胱炎，用更昔洛韦和膦甲酸钠联合治疗，以及免疫球蛋白治疗。患者治愈出院。确定血液中的CMVDNA与BALF中的CMVDNA不一致，延误了CMV肺炎的早期诊断。已知T细胞免疫功能与HSCT后CMV多器官感染的治疗功效之间的关联是显着的。此外，及时给予更昔洛韦和膦甲酸钠联合免疫球蛋白治疗显示出良好的临床结局.
