Autopsy and Case Reports
Autopsy and Case Reports
Autopsy Case Report

Cytomegalovirus pneumonia presenting as pulmonary nodules

Janet Basinger; Meghan E. Kapp

Downloads: 9
Views: 980


Cytomegalovirus (CMV) pneumonia is a well-known cause of morbidity and mortality in patients with a history of allogenic hematopoietic stem cell transplant. Radiographically, CMV pneumonia most commonly presents as bilateral ground glass opacities; however, the presentation is non-specific and can be variable, including presenting as areas of air-space consolidation or pulmonary nodules. We report a case of a 70-year-old man who presented with rapidly progressive bilateral pulmonary nodules approximately two months after receiving a bone marrow transplant. No infectious etiology was identified for the pulmonary nodules, and a bronchoscopy was unable to be performed due to a rapid decline in the patient’s overall condition and respiratory status. The patient died shortly after the decision was made to transition to palliative care and a limited autopsy was performed to explore the pulmonary findings. Corresponding to premortem imaging were the postmortem gross findings of numerous bilateral pulmonary nodules and a large mass-like area of consolidation in the right upper lobe. Microscopic examination of the nodules demonstrated a necrotizing pneumonia with few foci of viral cytopathologic change consistent with CMV, which was confirmed by immunohistochemistry. While CMV is a common infectious agent in the immunocompromised population, CMV pneumonia continues to be a challenging entity due to difficulty in diagnosis and treatment. Rapidly enlarging pulmonary nodules in an immunosuppressed patient is highly suggestive of an infectious process and careful histologic examination for viral cytopathologic change is essential.


Autopsy, Cytomegalovirus, Multiple Pulmonary Nodules, Pneumonia, Transplant Recipients


1 Erard V, Guthrie KA, Seo S, et al. Reduced mortality of cytomegalovirus pneumonia after hematopoietic cell transplantation due to antiviral therapy and changes in transplantation practices. Clin Infect Dis. 2015;61(1):31-9. PMid:25778751.

2 Torres HA, Aguilera E, Safdar A, et al. Fatal cytomegalovirus pneumonia in patients with haematological malignancies: an autopsy-based case–control study. Clin Microbiol Infect. 2008;14(12):1160-6. PMid:19046167.

3 Nguyen Q, Champlin R, Giralt S, et al. Late cytomegalovirus pneumonia in adult allogeneic blood and marrow transplant recipients. Clin Infect Dis. 1999;28(3):618-23. PMid:10194088.

4 Gasparetto EL, Ono SE, Escuissato D, et al. Cytomegalovirus pneumonia after bone marrow transplantation: high resolution CT findings. Br J Radiol. 2004;77(921):724-7. PMid:15447956.

5 Shimada A, Koga T, Shimada M, et al. Cytomegalovirus pneumonitis presenting small nodular opacities. Intern Med. 2004;43(12):1198-200. PMid:15645659.

6 Chen CS, Boeckh M, Seidel K, et al. Incidence, risk factors, and mortality from pneumonia developing late after hematopoietic stem cell transplantation. Bone Marrow Transplant. 2003;32(5):515-22. PMid:12942099.

7 Meyers JD, Ljungman P, Fisher LD. Cytomegalovirus excretion as a predictor of cytomegalovirus disease after marrow transplantation: importance of cytomegalovirus viremia. J Infect Dis. 1990;162(2):373-80. PMid:2165110.

8 Green ML, Leisenring W, Xie H, et al. Cytomegalovirus viral load and mortality after haemopoietic stem cell transplantation in the era of pre-emptive therapy: a retrospective cohort study. Lancet Haematol. 2016;3(3):e119-27. PMid:26947200.

9 Karakelides H, Aubry MC, Ryu JH. Cytomegalovirus pneumonia mimicking lung cancer in an immunocompetent host. Mayo Clin Proc. 2003;78(4):488-90. PMid:12683701.

10 Solomon IH, Hornick JL, Laga AC. Immunohistochemistry is rarely justified for the diagnosis of viral infections. Am J Clin Pathol. 2017;147(1):96-104. PMid:28007703.

11 Kotton CN, Kumar D, Caliendo AM, et al. The third international consensus guidelines on the management of cytomegalovirus in solid-organ transplantation. Transplantation. 2018;102(6):900-31. PMid:29596116.

Submitted date:

Accepted date:

Publication date:

6228ae11a953950b197d8612 autopsy Articles
Links & Downloads

Autops Case Rep

Share this page
Page Sections