Life-threatening cytomegalovirus-induced interstitial pneumonitis in a patient of membranous glomerulonephropathy with short-term immune-suppressant therapy

Cytomegalovirus (CMV) disease is not uncommon upon an acquired immune compromised status like organ transplant recipients. However, the complication of short-term immunosuppressive therapy for non-transplant patients was not known very well. Here we reported a case of CMV pneumonitis presented with life threatening respiratory failure in a patient with diabetes and steroid-resistant membraneous glomerulonephropathy who underwent immunosuppressant therapy. Chest X-ray and high resolution computed tomography scan revealed interstitial pneumonitis over both lungs. A virus isolation culture of bronchoalveolar lavage fluid and deoxyribonucleic acid polymerase chain reaction in peripheral blood showed positivity for CMV. After one month of ganciclovir therapy, the patient's symptoms improved and lung infiltration resolved. However, post-infection sequela of severe restrictive lung disease occurred and oxygen therapy was maintained after his discharge. CMV lung infection may be mainly due to immune compromised status in the present case of diabetes, steroid-resistant glomerulopathy, and treatment with cyclosporine immunosuppressant. A high index of suspicion and early initiation of antivirus therapy are mandatory for the successful management of opportunistic CMV pneumonitis and the sequelae in patients receiving immunosuppressive therapy.