Systematic Reviews
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Meta-Anal. Jun 18, 2023; 11(5): 151-166
Published online Jun 18, 2023. doi: 10.13105/wjma.v11.i5.151
Pulmonary cytomegalovirus infection: A case report and systematic review
Awotar Kanika, Jonathan Soldera
Awotar Kanika, Jonathan Soldera, Department of Acute Medicine, University of South Wales, Cardiff CF37 1DL, United Kingdom
Author contributions: Both authors contributed to writing and reviewing the final draft of the manuscript.
Conflict-of-interest statement: All the authors declare no conflict of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non-Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jonathan Soldera, MD, MSc, Associate Professor, Staff Physician, Department of Acute Medicine, University of South Wales, Cardiff CF37 1DL, Cardiff CF37 1DL, United Kingdom. jonathansoldera@gmail.com
Received: January 9, 2023
Peer-review started: January 9, 2023
First decision: February 20, 2023
Revised: April 8, 2023
Accepted: June 9, 2023
Article in press: June 9, 2023
Published online: June 18, 2023
Processing time: 158 Days and 2.2 Hours
Abstract
BACKGROUND

Cytomegalovirus (CMV) is a common virus that can cause the first infection in childhood or adolescence and reactivate later in life due to immunosuppression. CMV pneumonia is a rare illness in immunocompetent patients but is one of the most significant opportunistic infections in immunocompromised patients.

AIM

To report a case and review published cases of pulmonary CMV infection in both immunocompromised and immunocompetent patients.

METHODS

We conducted a systematic search on the MEDLINE (PubMed) database, without date or language restrictions, to identify relevant studies using Medical Subject Headings and Health Science Descriptors. We manually searched the reference lists of the included studies. Simple descriptive analysis was used to summarize the results.

RESULTS

Our search identified 445 references, and after screening, 43 studies reporting 45 cases were included in the final analysis, with 29 (64%) patients being immunocompromised and 16 (36%) being immunocompetent. Fever (82%) and dyspnea (75%) were the most common clinical findings. Thoracic computed tomography showed bilateral ground-glass opacities, a relevant differential diagnosis for severe acute respiratory syndrome coronavirus 2 infection. The majority of patients (85%) received antiviral therapy, and 89% of patients recovered, while 9% of patients died.

CONCLUSION

CMV pneumonia should be considered as a differential diagnosis for coronavirus disease 2019 pneumonia, especially in immunocompromised patients. Clinicians should be aware of the clinical presentation, management, and outcomes of CMV pneumonia to guide appropriate treatment decisions.

Keywords: Cytomegalovirus; Immunocompromised; Immunocompetent; Severe acute respiratory syndrome coronavirus 2; Coronavirus disease 2019; Ganciclovir

Core Tip: The paper reports a case of disseminated cytomegalovirus (CMV) infection in an immunocompetent patient who presented with cough, dyspnea, high-grade fever, and jaundice. The patient was diagnosed with CMV pneumonia after developing sepsis and being admitted to the intensive care unit. The study conducted a systematic search on the MEDLINE database to identify published cases of pulmonary CMV infection in both immunocompromised and immunocompetent patients. The search identified 43 studies reporting 45 cases, with 29 (64%) patients being immunocompromised and 16 (36%) being immunocompetent. Fever and dyspnea were the most common clinical findings, and thoracic computed tomography showed bilateral ground-glass opacities. The majority of patients received antiviral therapy, and 89% of patients recovered, while 9% of patients died. The study highlights that CMV pneumonia should be considered as a differential diagnosis for coronavirus disease 2019 pneumonia, especially in immunocompromised patients, and clinicians should be aware of the clinical presentation, management, and outcomes of CMV pneumonia to guide appropriate treatment decisions.