Post-CMV organizing pneumonia – An unusual presentation 10 years after kidney transplantation Singhal MK, Gaur L, Verma R, Tandon R,

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Official publication of the Indian Society of Nephrology

CASE REPORT

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Post-CMV organizing pneumonia – An unusual presentation 10 years after kidney transplantation Manoj K Singhal¹, Lovy Gaur¹, Ritu Verma², Rajesh Tandon³ ¹ Department of Nephrology and Kidney Transplantation, Max Superspeciality Hospital, Vaishali, Ghaziabad, Uttar Pradesh, India ² Department of Intervention Radiology, Max Superspeciality Hospital, Vaishali, Ghaziabad, Uttar Pradesh, India ³ Department of Histopathology, Max Superspeciality Hospital, Vaishali, Ghaziabad, Uttar Pradesh, India Correspondence Address: Lovy Gaur, Max Superspeciality Hospital, W-3, Sector-1, Vaishali, Ghaziabad, Uttar Pradesh India Source of Support: None, Conflict of Interest: None DOI: 10.4103/ijn.ijn_254_21

A 45-year-old gentleman underwent kidney transplantation in March 2010. He remained apparently healthy for the next 10 years when he developed anorexia and weight loss. Diagnostic workup revealed cytomegalovirus (CMV) pneumonia. While viremia resolved within 3 weeks of initiation of valganciclovir, he developed progressive breathlessness and hypoxia on exertion. Imaging of thorax revealed central peri-bronchovascular consolidation and fine reticulations with peripheral sparing. Computed tomography (CT)-guided percutaneous lung biopsy revealed organizing intra-alveolar exudates, suggestive of organizing pneumonia, with no evidence of active infection on biopsy as well as bronchoalveolar lavage (BAL) cytology. This atypical pattern of central distribution of opacities is not typical of organizing pneumonia where peripheral subpleural distribution is more common. Patient responded dramatically following escalation of steroids, with complete resolution of infiltrates on follow-up imaging.

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