Case 90. CMV pneumonia (6 mo-o F)
         
   
Marked peribronchial lymphocytic inflammation causing sudden infant death
   
         
   
Key words : 
cytomegalovirus, sudden infant death, peribronchial inflammation    
         
   
opportunistic infection
   
     
 
     
Peribronchial inflammatory nodules with prominent lymphoid follicle formation are multifocally observed. CMV myocarditis was associated in this case.   Close observation demonstrates intranuclear inclusions in some enlarged epithelial cells. Transbronchial transmission of CMV is suspected.
     
 
     
Cytomegalovirus DNA is demonstrable in both the intranuclear and cytoplasmic inclusion bodies, confirming the diagnosis of CMV infection (in situ hybridization).   Reference case 90A
Opportunistic lung infection of CMV in a lymphoma patient after extensive chemotherapy (HE). Enlarged pneumocytes contain large haloed, basophilic intranuclear inclusions and intracytoplasmic granular inclusions, characteristic of CMV infected cells.
     
 
     
Reference case 90B
Autopsied salivary gland of a neonate, showing CMV-infected ductal cells and chronic inflammation (HE). Transplacental CMV infection, provoking chronic inflammatory responses. CMV was originally called as salivary gland virus.
  Reference case 90B
Electron micrograph of cytoplasmic viral particles of CMV. Mature viral particles of herpes virus type are seen in and outside the rough endoplasmic reticulum (RER). The particles measuring 180 nm form an envelope. High electron density is noted in the core.
     
 
     
Reference case 90C
Sputum cytology from an AIDS patient, showing a typical CMV-infected cell with nuclear inclusion (Papanicolaou). A large, basophilic intranuclear inclusion is pathognomonic. Cytoplasmic inclusion is unclear here.
  Reference case 90C
Sputum cytology from an AIDS patient, showing a typical CMV-infected cell with nuclear inclusion (Giemsa). A large basophilic intranuclear inclusion and cytoplasmic granular inclusions are observed.