Wickramasinghe Sugeesha, Tillekeratne Menaka, Wijayawardhana Sasanka, Sadikeen Aflah, Priyankara Dilshan, Edirisooriya Manoj, Fernando Amitha
Department of Respiratory Medicine Central Chest Clinic Borella Sri Lanka.
Department of Critical Care National Hospital of Sri Lanka Borella Sri Lanka.
Respirol Case Rep. 2022 Jul 7;10(8):e01002. doi: 10.1002/rcr2.1002. eCollection 2022 Aug.
A 32-year-old patient, who was on treatment for tuberculous meningitis complicated with venous sinus thrombosis, was referred to the medical unit as he developed new onset fever, cough and shortness of breath. He was in respiratory distress and needed intubation. Investigations revealed elevated liver enzymes, leukopenia, spherocytosis and lower lobe predominant consolidations and diffuse nodules in the high-resolution computed tomography. He was suspected to have cytomegalovirus (CMV) pneumonia with the above results, and further investigations revealed an extremely elevated CMV viral load. He was treated with ganciclovir followed by valganciclovir for a total of 42 days resulting in a complete recovery. Liver functions resolved with anti-viral treatment, and he was started on full anti-tuberculosis (TB) treatment. Further investigations did not reveal evidence of immunosuppression. Association of CMV and TB is explained genetically, although clinical association is rarely described. The presence of either infection should lead to higher degree of suspicion of the respective other condition in relevant clinical setting.
一名32岁的患者，正在接受结核性脑膜炎合并静脉窦血栓形成的治疗，因出现新发发热、咳嗽和呼吸急促而被转诊至内科病房。他处于呼吸窘迫状态，需要插管。检查发现肝酶升高、白细胞减少、球形红细胞增多，高分辨率计算机断层扫描显示下叶为主的实变和弥漫性结节。根据上述结果，怀疑他患有巨细胞病毒（CMV）肺炎，进一步检查发现CMV病毒载量极高。他接受了更昔洛韦治疗，随后接受缬更昔洛韦治疗，共42天，最终完全康复。抗病毒治疗后肝功能恢复正常，他开始接受全程抗结核治疗。进一步检查未发现免疫抑制的证据。CMV和结核的关联在遗传学上有解释，尽管临床关联很少被描述。在相关临床环境中，任何一种感染的存在都应导致对另一种疾病的更高怀疑程度。
