Ohori N P, Michaels M G, Jaffe R, Williams P, Yousem S A
Department of Pathology, Montefiore-University of Pittsburgh Medical Center, PA, USA.
Hum Pathol. 1995 Oct;26(10):1073-9. doi: 10.1016/0046-8177(95)90268-6.
Although Adenovirus (ADV) pneumonia has been documented in bone marrow, kidney, and liver transplantation recipients, it has only been sporadically reported in lung transplantation recipients. Among our 308 lung transplantation recipients, we identified four who developed ADV pneumonia. Formalin-fixed paraffin-embedded biopsy and autopsy specimens on all cases were studied by routine histology, immunohistochemistry (IHC), and by in situ hybridization (ISH) for evidence of ADV, and the results were correlated with the patients' clinical progression. Three of the four patients were children, and all four had a progressive and rapidly fatal course within 45 days posttransplantation. The lungs showed necrotizing bronchocentric pneumonia with tendency to spread diffusely to produce alveolar damage and organizing pneumonia. The occurrence of this rapidly fatal ADV pneumonia mainly affecting the pediatric population, early in the posttransplantation course, suggests that the infection is primary to the recipient with ADV either originating and reactivating in the donor lung or acquired from the upper respiratory tract of the recipient. The characteristic smudgy intranuclear inclusions of ADV, as well as IHC and ISH positivity, were observed in the lungs of all autopsies. Antemortem biopsy demonstration of ADV by inclusion formation, IHC, and ISH was observed in two patients. In another patient, antemortem ADV was shown only by ISH, and the recognition of inclusions was made difficult by coexistent CMV infection. Although IHC and ISH may have the potential for detecting early infection, recognition of the characteristic clinical setting with necrotizing bronchocentric pneumonia and smudgy intranuclear inclusions should alert one to the diagnosis of ADV pneumonia.
尽管在骨髓、肾脏和肝脏移植受者中已有腺病毒（ADV）肺炎的记录，但在肺移植受者中仅有零星报道。在我们的308例肺移植受者中，我们确定了4例发生ADV肺炎的患者。对所有病例的福尔马林固定石蜡包埋活检和尸检标本进行常规组织学、免疫组织化学（IHC）和原位杂交（ISH）检测以寻找ADV证据，并将结果与患者的临床病程相关联。4例患者中有3例为儿童，所有4例在移植后45天内均出现进行性且迅速致命的病程。肺部表现为坏死性支气管中心性肺炎，有弥漫性扩散导致肺泡损伤和机化性肺炎的倾向。这种主要影响儿童群体、在移植后早期迅速致命的ADV肺炎的发生表明，感染对于受者来说是原发性的，ADV要么起源于供体肺并在其中重新激活，要么从受者的上呼吸道获得。在所有尸检的肺部均观察到ADV特征性的模糊核内包涵体，以及IHC和ISH阳性。在2例患者的生前活检中通过包涵体形成、IHC和ISH证实了ADV。在另一例患者中，生前仅通过ISH显示有ADV，并且由于同时存在巨细胞病毒（CMV）感染，难以识别包涵体。尽管IHC和ISH可能有检测早期感染的潜力，但认识到伴有坏死性支气管中心性肺炎和模糊核内包涵体的特征性临床情况应提醒人们警惕ADV肺炎的诊断。
