Cytomegalovirus pneumonia is the major infectious cause of death in recipients of allogeneic BMTs, with the mortality rate close to 85 percent. The pathogenesis of the pulmonary disease is poorly understood and remains controversial but intriguing. Antiviral agents alone have no significant impact on the high mortality, suggesting that the pathologic effect in the lungs may not be solely related to the virus alone. Recent studies using GIG together with an antiviral agent, DHPG, have shown a dramatic improvement in the survival rate. Grundy et al recently hypothesized that CMV pneumonia in allogeneic BMT recipients is an immunopathologic disease resulting from the stimulation of the hosts immune system by the virus.
In this report, we present the clinical course of an episode of CMV pneumonia in a BMT patient which lends support to the hypothesis of Grundy et al. The patient was successfully treated with combined therapy of GIG and DHPG; however, the apparent successful recovery was followed by the development of BOOP four months later. His pulmonary status was monitored throughout the course with clinical assessments, chest roentgenograms, PFTs, and serial bronchoscopy with BAL. The longitudinal data assembled suggest that there was persistent activation of the hosts immune system after the CMV pneumonia, which resulted in the BOOF