Cytomegalovirus (CMV) pneumonia can occur regardless of host immune status, however, the infection is latent in immunocompetent individuals. Reactivation of the virus is possible, and this leads to secondary infection.

In the context of a normally functioning immune system, infection is largely asymptomatic and full blown pneumonia is rare, even if infiltrates are visible radiologically. Fever, lymphadenopathy and flu-like symptoms, in what is termed CMV mononucleosis, with or without the presence of a cough, is the most frequently described clinical presentation. In the event that severe pneumonia is contracted, full recovery following initiation of antiviral treatment is typical.

In practice, most documented cases of cytomegalovirus pneumonia are confined to immunosuppressed individuals, and the disease is often severe and fatal. This includes those who have undergone chemotherapy, radiotherapy, long-term steroid therapy, organ and bone marrow transplant recipients and those suffering from acquired immunodeficiency syndrome (AIDS). The latter are at the highest risk when serum concentrations of T helper cells fall below 50 cells per cubic millimeter. Among those who receive organ transplants, the probability of CMV pneumonia differs; for instance those who receive cells or organs originating from another donor have up to a 30% risk, whereas those receiving their own harvested cells have a much lower risk (1%- 6%) [1]. Furthermore, bone marrow transplant recipients are the most susceptible to disease, with untreated case fatality rates of over 80%, and 15-75% with appropriate treatment [1]. Symptoms experienced include

Symptoms of CMV pneumonia include cough, fever, night sweats, respiratory distress, hypoxia, myalgia, arthralgia, and fatigue. Radiological evidence of disease can sometimes precede outward signs of infection. The infection may affect other organ systems simultaneously, thus provoking a wider symptom profile. As it is a life-threatening illness, immunosuppressed patients are habitually initiated on CMV prophylaxis [2] [3] [4].

Importantly, neonates can also suffer from cytomegalovirus pneumonia when they acquire the infection from infected mothers through the placenta, birth canal, or during and breastfeeding.

• Fever

  Fever and dyspnea were the most frequent symptoms. The most frequent radiological signs were bilateral pulmonary infiltrates. Six cases were complicated by hemophagocytic lymphohistiocytosis. [ncbi.nlm.nih.gov]

  Fever, lymphadenopathy and flu-like symptoms, in what is termed CMV mononucleosis, with or without the presence of a cough, is the most frequently described clinical presentation. [symptoma.com]

• Malaise

  Examination reveals crackles in the lungs and low oxygenation Loss of appetite, discomfort, general malaise or tiredness Muscular ache, fatigue, excessive sweating (at nights) Coughing blood with severe pneumonia Co-existing infections in the lung, such [dovemed.com]

  In immunocompetent patients 90%: asymptomatic course 10% : CMV mononucleosis Fever, malaise, myalgia / arthralgia, fatigue, headache Less common: sore throat, cervical lymphadenopathy, hepatomegaly, splenomegaly Differential diagnosis: infectious mononucleosis [amboss.com]

  Symptoms Cough Fatigue Fever General discomfort, uneasiness, or ill feeling (malaise) Loss of appetite Muscle aches or joint pains Shortness of breath Shortness of breath on exertion Sweating, excessive (night sweats) Low oxygen levels in the blood (hypoxemia [dxline.info]

  Symptoms may include: Cough Fatigue Fever General discomfort, uneasiness, or ill feeling ( malaise ) Loss of appetite Muscle aches or joint pains Shortness of breath Sweating, excessive (night sweats) The goal of treatment is to use antiviral drugs to [medlineplus.gov]

• Chills

  She had fevers, chills, a red rash, muscle pain, and joint pains. She works in a daycare center, and some of her colleagues had similar symptoms. This resolved in 1 week. Today, there are no significant findings on physical exam. [medbullets.com]

  If you are a healthy adult, call your doctor if you have severe abdominal pain, vomiting or fevers that last longer than 48 hours or if you have significant fatigue, sweats, chills or are losing weight. [drugs.com]

  In some people, the virus causes mild symptoms that mimic the flu or infectious mononucleosis, such as fever, chills, body aches, headache, swollen lymph nodes *, sore throat, and fatigue. [humanillnesses.com]

• Turkish

  Abstract A case of hypertrophic osteoarthropathy is reported in a 3-year-old Turkish girl. She had combined immunodeficiency, later shown to be the bare lymphocyte syndrome, and chronic pneumonia. Lung biopsy showed cytomegalovirus. [ncbi.nlm.nih.gov]

• Cough

  A 24-year-old male was admitted to the hospital with complaints of cough, fever and dyspnoea. He was receiving immunosuppressive therapy for polyarteritis nodosa. [ncbi.nlm.nih.gov]

  Fever, lymphadenopathy and flu-like symptoms, in what is termed CMV mononucleosis, with or without the presence of a cough, is the most frequently described clinical presentation. [symptoma.com]

  Hypoxia, if extreme, may be fatal. cytomegalovirus pneumonia Pulmonology A viral pneumonia characterized by fever, non-productive cough, SOB and association with PCP, especially in AIDS; hypoxia, if extreme, may be fatal. [medical-dictionary.thefreedictionary.com]

• Dyspnea

  Fever and dyspnea were the most frequent symptoms. The most frequent radiological signs were bilateral pulmonary infiltrates. Six cases were complicated by hemophagocytic lymphohistiocytosis. [ncbi.nlm.nih.gov]

  All patients of CMV pneumonia had dyspnea, 90% had fever and 71% had cough. [erj.ersjournals.com]

  A 29 year-old female with a history of systemic lupus erythematosus presented with a seven-day history of fever, dyspnea and a non-productive cough. [swjpcc.com]

  following bone marrow transplant or in HIV / AIDS patients with CD4 50 cells/mm 3 ) Clinical findings: fever, nonproductive cough, dyspnea Diagnostics: Chest x-ray : diffuse bilateral interstitial infiltrates Detection of CMV in bronchoalveolar lavage [amboss.com]

• Dry Cough

  The signs and symptoms of CMV Pneumonia are: Fever, dry cough, and shortness of breath, are the most common symptoms. [dovemed.com]

  cough If you're HIV-positive, your chance of becoming sick with CMV is greatest when your CD4 count is below 100. [webmd.com]

• Tachypnea

  CONCLUSIONS: CMV pneumonia should always be suspected in IBD patients who present with fever and tachypnea, especially if the latter is worsening and/or is associated with dyspnea. Treatment must be early and specific. [ncbi.nlm.nih.gov]

  Conclusion We report an acute CMV infection case, which presented with fever, cough, sputum and tachypnea. The latter deteriorated rapidly and is associated with respiratory failure. [aclr.com.es]

The diagnosis of CMV pneumonia combines both clinical observation and medical imaging. Chest X-ray and computerized tomography (CT) scan are the relevant imaging techniques. They may show ground glass or patchy opacities across both lung fields [5] [6]. Despite this, possible X-ray and CT findings are variable.

Laboratory tests involve collecting tissue samples from the blood, urine or alveoli through bronchoalveolar lavage. These samples are used for serology through the means of immunological assays, viral culture, and DNA polymerase chain reaction (PCR). Caution should be exercised when interpreting results, as they can be misleading. Histopathologic diagnosis, for which a lung biopsy is needed, is more accurate but may prove hazardous for bedridden patients [7].

• Pulmonary Infiltrate

  A 61-year-old woman who had undergone an operation for thymoma 17 years previously suddenly became dyspneic and showed bilateral pulmonary infiltrates on a chest radiograph. [ncbi.nlm.nih.gov]

  There are few studies reported the correlation of clinical, and pulmonary infiltration with histopathological evidence of CMV pneumonia. [erj.ersjournals.com]

  infiltrate and organ dysfunction. [journals.lww.com]

  The only morbidity occurred in two patients who had fever and a pulmonary infiltrate in the lung segments subjected to lavage within 24 hours after the procedure. [nejm.org]

• Bilateral Pulmonary Infiltrate

  A 61-year-old woman who had undergone an operation for thymoma 17 years previously suddenly became dyspneic and showed bilateral pulmonary infiltrates on a chest radiograph. [ncbi.nlm.nih.gov]

• Bilateral Pulmonary Infiltrate

  A 61-year-old woman who had undergone an operation for thymoma 17 years previously suddenly became dyspneic and showed bilateral pulmonary infiltrates on a chest radiograph. [ncbi.nlm.nih.gov]

• Cavitary Lesion

  Following CMV pneumonia, cavitary lesions again occurred in the patient's lungs that were thought to be the first case of cavitary lesions caused by Nocardia asiatica infection. [ncbi.nlm.nih.gov]

• Ground Glass Appearance

  A high-resolution CT thorax showed diffuse multilobular ground glass appearance with peripheral nodular shadowing, consistent with a viral pneumonia. CMV IgM antibody was positive and CMV PCR was positive on two subsequent occasions. [ncbi.nlm.nih.gov]

• Viral Inclusion Body

  Some of the alveolar spaces were lined by large cells containing homogenous dark purple viral inclusion bodies, surrounded by a characteristic halo, suggestive of CMV infection [Figure 3]. [ijpmonline.org]

  The pathologic hallmark of CMV infection is an enlarged cell with viral inclusion bodies. Cells that exhibit cytomegaly are also seen in infections caused by other Betaherpesvirinae. [emedicine.medscape.com]

1. Kotloff RM, Ahya VN, Crawford SW. Pulmonary complications of solid organ and hematopoietic stem cell transplantation. Am J Respir Crit Care Med. 2004;170(1):22–48.
2. Singh N, Dummer JS, Kusne S, et al. Infections with cytomegalovirus and other herpesviruses in 121 liver transplant recipients: transmission by donated organ and the effect of OKT3 antibodies. J Infect Dis. 1988;158(1):124–131.
3. Vigil KJ, Adachi JA, Chemaly RF. Viral pneumonias in immunocompromised adult hosts. J Intensive Care Med. 2010;25(6):307–326.
4. Boeckh M, Ljungman P. How we treat cytomegalovirus in hematopoietic cell transplant recipients. Blood. 2009;113(23):5711–5719.
5. Moon JH, Kim EA, Lee KS, Kim TS, Jung KJ, Song JH. Cytomegalovirus pneumonia: high-resolution CT findings in ten non-AIDS immunocompromised patients. Korean J Radiol. 2000;1(2):73–78.
6. Franquet T, Lee KS, Muller NL. Thin-section CT findings in 32 immunocompromised patients with cytomegalovirus pneumonia who do not have AIDS. AJR Am J Roentgenol. 2003;181(4):1059–1063.
7. Zhao XS, Liu DH, Xu LP, et al. [Clinical features of cytomegalovirus pneumonia after allogeneic hematopoietic stem cell transplantation] Beijing Da Xue Xue Bao. 2009;41(5):548–553.