Case Report: Cytomegalovirus-associated granulomatous lung disease in an immunocompetent preterm infant
- 1Department of Pediatric Intensive Care Unit, Shanghai Children’s Hospital, Shanghai Jiao Tong University School of Medicine
- 2Department of Cardiothoracic Surgery, Shanghai Children’s Hospital, Shanghai Jiao Tong University School of Medicine
Abstract
Granulomatous lung disease caused by cytomegalovirus (CMV) has not been described in immunocompetent infants. We report a 5-month-old boy, born at 31 ⁺⁵ weeks of gestation, with a 2-month history of isolated cough and normal growth. Contrast-enhanced chest computed tomography showed a multiloculated cystic mass in the right upper lobe. CMV DNA was detected in whole blood (1.41 × 10 ⁴ copies/mL) and urine (1.44 × 10 ⁶ copies/mL). Intravenous ganciclovir for 2 weeks produced no radiological change; because a tumor could not be excluded, video-assisted thoracoscopic right upper lobectomy was performed. Histology showed extensive necrosis with well-formed epithelioid granulomas and multinucleated giant cells. Stains for acid-fast bacilli and fungi and Epstein-Barr virus-encoded RNA in situ hybridization were negative. To exclude an infectious granulomatous disease, metagenomic next-generation sequencing (mNGS) of the resected tissue identified CMV at 1,143 reads per million as the only pathogen. The postoperative course was uncomplicated, with no recurrence at 6 months. CMV produced a localized granulomatous mass mimicking a congenital lung lesion or neoplasm, and tissue mNGS provided the decisive microbiological evidence. When a preterm infant has an unexplained chronic pulmonary lesion, CMV should be considered, and mNGS of pathological tissue can establish the diagnosis.
Related
- Cytomegalovirus-associated Disseminated Intravascular Coagulation in an Immunocompetent Patient: A Case Report and Literature Review
- Prolonged Primary Cytomegalovirus Infection in an Immunocompetent Adult Successfully Treated With Valganciclovir
- Cytomegalovirus Viremia Is Strongly Associated With 6-Month Mortality Among Adults Living With Advanced HIV Disease: A Prospective Cohort Study in South Africa
- Severe capillary leak syndrome caused by postnatal cytomegalovirus infection in a very preterm infant: a case report
- Elevated Anti-Cytomegalovirus IgG Levels Are Associated with Higher Erythropoiesis-Stimulating Agent Dose in Transplant-Listed Patients with End-Stage Kidney Disease
BibTeX
@article{zhou2026case,
title = {{Case Report: Cytomegalovirus-associated granulomatous lung disease in an immunocompetent preterm infant}},
author = {Yiping Zhou and Yaru Zhang and Rufang Zhang and Yucai Zhang and Yun Cui},
journal = {Frontiers in Immunology},
year = {2026},
month = oct,
doi = {10.3389/fimmu.2026.2000675},
url = {https://www.frontiersin.org/articles/10.3389/fimmu.2026.2000675/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Case Report: Cytomegalovirus-associated granulomatous lung disease in an immunocompetent preterm infant
AU - Yiping Zhou
AU - Yaru Zhang
AU - Rufang Zhang
AU - Yucai Zhang
AU - Yun Cui
PY - 2026
DA - 2026/10/09
JO - Frontiers in Immunology
DO - 10.3389/fimmu.2026.2000675
UR - https://www.frontiersin.org/articles/10.3389/fimmu.2026.2000675/full
AB - Granulomatous lung disease caused by cytomegalovirus (CMV) has not been described in immunocompetent infants. We report a 5-month-old boy, born at 31 ⁺⁵ weeks of gestation, with a 2-month history of isolated cough and normal growth. Contrast-enhanced chest computed tomography showed a multiloculated cystic mass in the right upper lobe. CMV DNA was detected in whole blood (1.41 × 10 ⁴ copies/mL) and urine (1.44 × 10 ⁶ copies/mL). Intravenous ganciclovir for 2 weeks produced no radiological change; because a tumor could not be excluded, video-assisted thoracoscopic right upper lobectomy was performed. Histology showed extensive necrosis with well-formed epithelioid granulomas and multinucleated giant cells. Stains for acid-fast bacilli and fungi and Epstein-Barr virus-encoded RNA in situ hybridization were negative. To exclude an infectious granulomatous disease, metagenomic next-generation sequencing (mNGS) of the resected tissue identified CMV at 1,143 reads per million as the only pathogen. The postoperative course was uncomplicated, with no recurrence at 6 months. CMV produced a localized granulomatous mass mimicking a congenital lung lesion or neoplasm, and tissue mNGS provided the decisive microbiological evidence. When a preterm infant has an unexplained chronic pulmonary lesion, CMV should be considered, and mNGS of pathological tissue can establish the diagnosis.
SN - 1664-3224
ER -