CMV Pneumonitis with Bilateral Pleural and Pericardial Effusion in A Child with Non Hodgkin Lymphoma

A 12-year-old boy, known case of T-lymphoblastic lymphoma who was on 35th day of induction phase was admitted to the oncology department due to fever and neutropenia. He had received weekly vincristine for 4 weeks, 2 doses of doxorubicin and one dose of cyclophosphamide 1 gr/m2 along with PEG and also corticosteroids for the whole induction period. Broadspectrum antibiotics for coverage of most probable bacterial pathogens was started for the patient. He developed higher fever, progressive dyspnea and respiratoy distress in the next few days following admission. Chest- X-ray showed bilateral moderate pleural effusion and cardiomegaly. Trimethoprim-sulfamethoxazole 20 mg/ kg/day was started as empiric therapy for pneumocystis Jiroveci. Chest tomography revealed bilateral moderatesized pleural effusion along with pericardial effusion and also a consolidation in left middle lobe parenchyma with small centrilobular nodules of soft-tissue attenuation mimicking tree-in-bud appearance (Figure 1 A, B). Chest tube and pericardial window was inserted for the patient. Cytology and flowcytometric analysis of the pleural fluid was negative for lymphoma cells. It was a transudative fluid negative for fungi such as candida and aspergillus species and mucoracea by PCR; however, quantitative PCR for CMV-DNA was reported positive with a high copy number.