Chest
Volume 103, Issue 6, June 1993, Pages 1918-1920
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Selected Reports
Cytomegalovirus Pneumonitis: An Unusual Cause of Pulmonary Nodules in a Patient With AIDS

https://doi.org/10.1378/chest.103.6.1918Get rights and content

A patient with AIDS and a history of non-Hodgkin's lymphoma developed a generalized illness associated with the appearance of multiple pulmonary nodules on a chest radiograph. Cytomegalovirus infection was demonstrated by needle aspiration cytology. The patient's symptoms and radiographic abnormalities resolved completely on ganciclovir therapy. This unusual case (1) broadens the differential diagnosis of nodular pulmonary disease in patients with AIDS and (2) suggests that cytomegalovirus can cause clinically significant lung disease which may respond to standard antiviral therapy in patients with AIDS.

(Chest 1993; 103:1918-20)

Section snippets

CASE REPORT

A 35-year-old man presented to the AIDS Clinic at the University of California, San Francisco, in August 1991, complaining of fever, malaise, fatigue, abdominal pain and a hoarse voice for the preceding two weeks. In 1987, a serologic test for HIV infection was positive and CD4 + T-lymphocyte count was 160 cells/mm3. Zidovudine and aerosolized pentamidine were prescribed. Kaposi's sarcoma developed in June 1990 but required no therapy. Non-Hodgkin's lymphoma was diagnosed by biopsy of an

DISCUSSION

The differential diagnosis of nodular lung disease in patients with AIDS is extensive and includes tuberculosis, P carinii infection, cryptococcosis, Kaposi's sarcoma and non-Hodgkin's lymphoma. When CMV pneumonitis has been described in AIDS patients, the radiographic appearance has been that of diffuse bilateral interstitial infiltrates.3 To our knowledge, no case of nodular lung disease caused by CMV infection has been reported.

Clinically significant CMV pneumonitis responsive to antiviral

ACKNOWLEDGMENT

The authors thank Nadine Lurie for editorial assistance.

REFERENCES (10)

There are more references available in the full text version of this article.

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    Schulman et al4 showed that in the 15 of 159 LT recipients who acquired PNs after 11 months of follow-up, Aspergillus and mycobacterial infections, as well as PTLD, accounted for 80% of PNs. There were also reports of nodular opacities following FB and TBBX due to focal hematomas,10 multiple rib fractures that mimicked PNs,11 and rare causes such as pulmonary tuberculosis,12 CMV pneumonitis,13 BO organizing pneumonia,14 and recurrent sarcoidosis.15 To date, our study of 23 LT recipients with PNs represents the largest series.

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