The patient, a 31-year-old man with acute myeloblastic leukemia in remission, received a phenotypically HLA-identical marrow from his mother in December 1987. Before BMT, both were negative for CMV serology. The patient is a nonsmoker with no prior history of pulmonary disease. Before BMT the chest x-ray film and PFTs were normal. On the 25th day after BMT, the patient developed diarrhea with a low-grade fever and generalized cutaneous rash. Skin biopsy was consistent with acute CVHD. The patient was started on therapy with methylprednisolone at 40 mg/mVday, with good response. Subsequently, he was maintained on therapy with prednisone at 80 mg/day for three months and then tapered to a dosage of 25 mg/ day.
On the 64th day, the patient presented with a history of several days of nasal congestion, sinusitis, dry cough, and low-grade fever. His chest x-ray film showed bilateral basilar interstitial infiltrates. The BAL fluid was positive for CMV by both early antigen monoclonal antibody and cell culture techniques; typical nuclear inclusions indicative of CMV infection were noted in a few macrophages on cytopathologic examination. Analysis of the BAL showed a substantial lymphocytosis of 60 percent (Table 1). Urine was negative for CMV No other infective pathogens were identified. The patient was treated with DHPG (6 mg/kg/day for 14 days) and GIG.
Table 1—CUnical-Laboratory Profile
|Months after BMT|
|Cell differential of BAL, percent|
|Chest x-ray film||Bilateralinfiltrates||Normal||Normal||Bilateralinfiltrates|