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CMV pneumonitis in a patient with Crohn’s disease taking azathioprine
  1. Timothy Zef Hawthorne1,
  2. Rachel Shellien1,
  3. Lucy Chambers1 and
  4. Graham Devereux1,2
  1. 1Respiratory Medicine, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
  2. 2Respiratory Medicine, Liverpool School of Tropical Medicine, Liverpool, UK
  1. Correspondence to Dr Timothy Zef Hawthorne; tzh{at}doctors.org.uk

Abstract

This case report discusses the rare presentation of cytomegalovirus (CMV) pneumonitis in a young patient with moderately severe Crohn’s disease managed with low dose azathioprine. CMV pneumonitis was initially suspected on CT chest images and confirmed by PCR for CMV. She was treated with intravenous ganciclovir and later stepped down to oral valganciclovir. Although this patient had a prolonged and complicated hospital admission, a good clinical outcome was achieved. CMV infection was raised as an early differential and antiviral treatment was started without delay. This case study, therefore, makes the case for increased awareness of the possibility of, and recognition of CMV pneumonitis among healthcare professionals as a way of preventing significant morbidity and mortality. It also raises awareness of checking for slow metabolisers of azathioprine before initiation to look for individuals who may be at increased risk of azathioprine’s adverse effects.

  • infections
  • crohn's disease
  • unwanted effects / adverse reactions
  • pneumonia (respiratory medicine)

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Footnotes

  • Contributors TZH: submitting author, edited script, wrote discussion and oversaw formatting of final manuscript, collected information about patient’s admission from notes including previous clinic letters, acquired images, responded to reviewer’s comments. RS: contributing author, wrote case report section and edited text, discussed case report with patient and gained signed consent. LC: contributing author, wrote introduction, case report and edited text. GD: consultant who looked after patient during admission, read through and edited text to make corrections and improve overall picture.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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