Journal List > J Rheum Dis > v.22(6) > 1064231

Park, Jang, Kim, Park, Kim, Song, Kim, and Jin: Cavitary Lung Lesion in a Patient with Systemic Lupus Erythematosus: An Unusual Manifestation of Cytomegalovirus Pneumonia


Cytomegalovirus (CMV), a member of the human herpesvirus group, causes severe disease in immunocompromised patients. In particular, CMV pneumonia can be a life-threatening disease to patients taking immunosuppressive drugs. The radiographic manifestations of CMV are variable and may consist of reticular or reticulonodular patterns, ground-glass opacities, air-space consolidations, or mixed patterns. A cavitary lesion in pneumonia associated with CMV infection is extremely rare. Herein we report on a case of CMV pneumonia which presented with a cavitary lesion and was treated successfully in a systemic lupus erythematosus patient who was taking immunosuppressive drugs.


1. Juárez M, Misischia R, Alarcón GS. Infections in systemic connective tissue diseases: systemic lupus erythematosus, scleroderma, and polymyositis/dermatomyositis. Rheum Dis Clin North Am. 2003; 29:163–84.
2. Leland DS, Emanuel D. Laboratory diagnosis of viral infections of the lung. Semin Respir Infect. 1995; 10:189–98.
3. Kang EY, Patz EF Jr, Müller NL. Cytomegalovirus pneumonia in transplant patients: CT findings. J Comput Assist Tomogr. 1996; 20:295–9.
4. Gadkowski LB, Stout JE. Cavitary pulmonary disease. Clin Microbiol Rev. 2008; 21:305–33.
5. Najjar M, Siddiqui AK, Rossoff L, Cohen RI. Cavitary lung masses in SLE patients: an unusual manifestation of CMV infection. Eur Respir J. 2004; 24:182–4.
6. Karakelides H, Aubry MC, Ryu JH. Cytomegalovirus pneumonia mimicking lung cancer in an immunocompetent host. Mayo Clin Proc. 2003; 78:488–90.
7. Katagiri A, Ando T, Kon T, Yamada M, Iida N, Takasaki Y. Cavitary lung lesion in a patient with systemic lupus erythematosus: an unusual manifestation of cytomegalovirus pneumonitis. Mod Rheumatol. 2008; 18:285–9.
8. Azuma N, Hashimoto N, Yasumitsu A, Fukuoka K, Yokoya-ma K, Sawada H, et al. CMV infection presenting as a cavitary lung lesion in a patient with systemic lupus erythematosus receiving immunosuppressive therapy. Intern Med. 2009; 48:2145–9.
9. Lee DH, Kim JW, Shin DH, Oh MD, Song YW, Choi KW, et al. A case of cytomegalovirus pneumonitis in a patient with systemic lupus erythematosus. Korean J Med. 1999; 56:103–7.
10. Han SH, Sohn YJ, Park MA, Lee S, Ryu SH, Lim TH, et al. A case of cytomegalovirus pneumonia and retinitis in a patients with systemic lupus erythematosus. J Korean Rheum Assoc. 2003; 10:456–61.

Figure 1.
Chest plain radiography shows a large cavitary mass like lesion in the right upper lung field (arrow).
Figure 2.
Chest computed tomography with coronal reformatted image shows a large cavitary mass like lesion in the right upper lobe.
Figure 3.
(A) The irregularly dilated alveoli showed mononuclear inflammatory cell infiltration in the interstitium and multiple intranuclear cytomegalovirus inclusions in the alveolar pneumonocytes (arrows) (H&E, ×400). (B) Immunohistochemistry (IHC) with an-ti-cytomegalovirus (CMV) confirmed the CMV infected pneumonocytes with intranuclear inclusions (arrows) (IHC, ×400).
Figure 4.
After treatment of cytomegalovirus pneumonia, the size of cavitary lung lesion was decreased.
Similar articles