Department of Medicine and Surgery, Clinica Medica, University of Milano-Bicocca, San Gerardo Hospital, Via G.B. Pergolesi 33, 20900, Monza, Italy.
Division of Infectious Diseases, San Gerardo Hospital, Via G.B. Pergolesi 33, 20900, Monza, Italy.
BMC Infect Dis. 2019 Jan 9;19(1):34. doi: 10.1186/s12879-018-3621-8.
Cytomegalovirus is responsible for an opportunistic infection that can be life threatening in immunocompromised patients, while it is usually mild or completely asymptomatic in immunocompetent subjects. In the recent years, however, some cases of severe cytomegalovirus infection in immunocompetent patients have been reported, showing this to be a less rare occurrence than previously reported.
We report the case of an 83-year-old man, admitted to our hospital for gastroenteritis, complicated by dehydration and severe prothrombin time prolongation due to oral anticoagulant therapy accumulation, who developed hospital-acquired pneumonia; neither of these illnesses responded to several lines of antibiotic therapy. All microbiologic tests were negative, except cytomegalovirus DNA test in blood, which showed high viral load. Antiviral therapy with ganciclovir was then started and a quick favourable response followed. A state of immunodeficiency was excluded, based on normal CD4 count and patient's clinical history.
Different risk factors for severe cytomegalovirus disease in immunocompetent patients may exist, besides the ones already known, which could be responsible for severe cytomegalovirus disease in immunocompetent patients; thus, these patients should be tested for cytomegalovirus infection, if the clinical picture is compatible, to avoid delay in diagnosis and allow prompt start of specific therapy.
巨细胞病毒可引起机会性感染，在免疫功能低下的患者中可能具有致命性，而在免疫功能正常的患者中通常为轻度或无症状。然而，近年来，有报道称免疫功能正常的患者中发生了一些严重的巨细胞病毒感染病例，表明这种情况比以前报道的更为罕见。
我们报告了一例 83 岁男性患者的病例，该患者因肠胃炎入院，因口服抗凝剂治疗积累而导致脱水和严重凝血酶原时间延长，继而并发医院获得性肺炎；这些疾病均对多种抗生素治疗方案无反应。除血液中巨细胞病毒 DNA 检测显示病毒载量高外，所有微生物学检测均为阴性。随后开始给予更昔洛韦抗病毒治疗，患者迅速好转。根据 CD4 计数正常和患者的临床病史，排除了免疫缺陷状态。
除了已知的危险因素外，免疫功能正常的患者可能存在其他导致严重巨细胞病毒疾病的危险因素，因此，如果临床表现相符，这些患者应进行巨细胞病毒感染检测，以避免延误诊断并及时开始特定治疗。
