Polmonite interstiziale da citomegalovirus in adolescente immunocompetente: trattamento con it Ganciclovir

Interstitial pneumonia is the most common disease caused by infection from cytomegalovirus (CMV) in immunodepressed patients, whereas it is a rare complication in immunocompetent patients. With reference to the second group of patients, little literature has been produced as to the therapy to choose when symptoms are serious. We report the case of an immunocompetent adolescent with CMV pneumonitis who responded dramatically to therapy with Ganciclovir. For a week B.M., a 15 year old girl, has been showing fever, cough and boring pain at her left thoracic base. When hospitalized, the girl was suffering and dyspneic, cardio-thoracic conditions were bad. Spleen and liver were palpable two fingers from the costal arch. Haematochemical tests showed an increase in phlogosis and transaminase value. Thoracic X-ray was negative, as well as cultures. Among the serological tests high response of anti-CMV IgM was remarkable. Virological blood test confirmed active CMV infection. On the fifth day, a thoracic radiogrpahy showed widespread interstitial infiltrates. Treatment with Ganciclovir - i.v. 6 mg/kg day, twice a day for twelve days - has been then adopted. After two days of treatment, the girl was apyretic and eupnoic. After ten days of treatment, thoracic radiography was negative and a great decrease in CMV antigenic response was given by blood tests. No side effects were observed. According to our experience we can say that treatment with Ganciclovir may positively shorten the course of pneumonia caused by CMV in immunocompetent patients.

La polmonite interstiziale e la manifestazione pin comune dell'infezione acquisita da citomegalovirus (CMV) nei soggetti immunodeficienti, mentre e una rara complicanza nell'ospite immunocompetente 2. La terapia dell'infe¬zione acquisita da CMV nei pazienti senza deficit immuno¬logici si rende opportuna nei casi con compromissione dello stato generale e conclamata sintomatologia dispnoi¬ca 3. Se l'esperienza del trattamento con Ganciclovir 1, un nucleoside analogo alla timidina, nella polmonite da CMV in pazienti affetti da AIDS o sottoposti a trapianto di mi¬dollo e vasta, pochi dati sono forniti in letteratura sul suo utilizzo nella pneumopatia con importante quadro sinto¬matologico nei soggetti immunocompetenti ". Riportiamo il caso di una adolescente immunocompetente affetta da polmonite interstiziale in sindrome mononu¬cleosica indotta da CMV che ha prontamente riposto alla sola terapia con il Ganciclovir.