Cytomegalovirus Pneumonia After Hematopoietic Stem Cell Transplantation Four Cases Report And Literature

Objective: Improve clinicians' understanding of cytomegalovirus pneumonia after hematopoietic stem cell transplantation.Methods: To collect clinical data of 4 cases of cytomegalovirus pneumonia after hematopoietic stem cell transplantation in the First Affiliated Hospital of Guangxi Medical University from January to April 2019,and analysis of the clinical features,diagnosis,treatment and prognosis of the disease.And review related literature.Results: In this study,4 patients were male,3 of them had acute graft-versus-host disease,2 had respiratory failure,diffuse alveolar hemorrhage,and 4 patients all started within 100 days after hematopoietic stem cell transplantation.The clinical manifestations were Cough,hypoxemia,difficulty breathing,hemoptysis.The lungs were mainly characterized by audible and dry and wet voices,and one of them had no obvious positive signs in the lungs.All the 4 patients underwent chest CT examination.Among them,3 patients had different degrees of ground glass on chest CT,2 patients had diffuse two lungs and glass,and 1 patient had double lower lungs.All 4 patients underwentbronchoscopy,and the CMV-DNA copies of alveolar lavage fluid were increased to varying degrees.Among them,2 patients had enlarged nucleus of alveolar lavage fluid,large nuclear heterogeneous cells,and characteristic giant cells.Change.Four patients were treated with antiviral combined immunoglobulin to improve immunity,3 patients were treated with ganciclovir and sodium foscarnet for antiviral therapy,and 1 patient was treated with ganciclovir for antiviral therapy.After treatment,the symptoms and chest CT improved,and the condition was stable during follow-up;2 patients with respiratory failure and diffuse alveolar hemorrhage died.Review of the literature:12 patients(85.7%)developed onset within 100 days after hematopoietic stem cell transplantation.The clinical manifestations of 14 patients were mainly dyspnea(78.5%),fever(57.1%),hypoxemia(35.7%),and cough(21.4%),hemoptysis,etc.,imaging examination mainly showed grinding glass shadow(50%),interlobular septal thickening,solid shadow,strip-like shadow,bronchiectasis and so on.Three patients had graft-versus-host disease,and two patients had diffuse alveolar hemorrhage.10 cases underwent bronchoscopy,6cases had positive CMV-DNA copy of alveolar lavage fluid,2 cases showed CMV inclusion body in lung biopsy,4 cases did not undergo bronchoscopy,and1 case underwent surgical removal of lung mass,pathology There are CMV inclusion bodies,and 5 patients have only diagnosed CMV pneumonia by improving the symptoms of antiviral therapy.The antiviral treatment drugs are ganciclovir and sodium foscarnet,and there are 7 cases(50%)combined with antiviral drugs and immunoglobulins.Protein enhances immunotherapy,and 5of them are combined with ganciclovir and immunoglobulin to improve immunity.Eight patients(57.1%)improved after treatment,6 patients(42.8%)died,the main cause of death was respiratory failure(66.6%),and diffusealveolar hemorrhage(33.3%).Conclusions:(1)Most CMV pneumonia after hematopoietic stem cell transplantation occurs within 100 days after transplantation;(2)The main manifestations of this disease are fever,cough,dyspnea,hypoxemia and imaging findings of diffuse or double lung grinding;(3)CMV-DNA copy positive in alveolar lavage fluid and cytological discovery of giant cell changes are important for the diagnosis of CMV pneumonia;(4)The treatment of CMV pneumonia is the first choice of ganciclovir anti-viral combined with immunoglobulin to improve immunity.If the effect is not good,replace or combine with sodium foscarnet;(5)The disease has a high mortality rate and should be diagnosed early and treated early.