Cytomegalovirus pneumonia in a renal transplant patient
Fevers for 2 weeks. Increasing SPB over the same period. Renal transplant recipient, immunosuppressed.
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Multiple small ill-defined nodules in both lungs. There are changes of air space opacification and consolidation present. There are features of extensive tree-in-bud also in both lungs. Bronchiectatic changes are noted bilaterally. There is no mediastinal or pleural abnormality.
The findings are those of an infective process. TB and atypical mycobacteria, fungal and viral aetiologies as well as PCP should be included in the differential diagnosis
Microbiology post bronchoscopy was positive for cytomegalovirus infection. No TB or atypical mycobacteria was isolated, with no evidence of PCP seen in the bronchial washing specimens.
The typical findings seen in CMV pneumonitis on CT are:
- multiple nodules
- areas of peripheral consolidation predominantly involving the lung bases