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Vol. 14. Issue 1.
Pages 151-157 (January - February 2008)
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Vol. 14. Issue 1.
Pages 151-157 (January - February 2008)
Caso Clínico/Clinical Case
Open Access
Pneumonia por Pneumocystis e citomegalovírus no doente VIH – A propósito de dois casos clínicos
Pneumocystis and cytomegalovirus pneumonia in HIV patients – Two clinical cases
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Sofia Lourenço1,
Corresponding author
sofilourenco@hotmail.com

Correspondência: Sofia Lourenço, Hospital de Curry Cabral, Unidade de Cuidados Intensivos, Rua da Beneficência, 8, 1069-166 Lisboa.
, Marta Amaral1, Raquel Almeida1, Paulo Marcelino2, Susan Marum2, M.ª Adelaide Milheiro3, Judite Oliveira4, Luís Mourão5
1 Interna do Internato Complementar de Medicina Interna, Hospital de Curry Cabral, Unidade de Cuidados Intensivos
2 Assistente Hospitalar de Medicina Interna, subespecialista em Medicina Intensiva, Hospital de Curry Cabral, Unidade de Cuidados Intensivos
3 Assistente Hospitalar Graduado de Anatomia Patológica, Hospital de Curry Cabral, Unidade de Cuidados Intensivos
4 Assistente Hospitalar Graduado de Medicina Interna, Hospital de Curry Cabral, Unidade de Cuidados Intensivos
5 Assistente Hospitalar Graduado de Medicina Interna, Director de Serviço, Hospital de Curry Cabral, Unidade de Cuidados Intensivos
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Resumo

Nos doentes com infecção pelo vírus da imunodeficiência humana (VIH) o citomegalovírus torna-se um agente de doença importante quando existe imunossupressão avançada. O seu papel como agente de doença pulmonar neste contexto tem sido amplamente debatido. Nos doentes com pneumocistose, a presença do citomegalovírus no pulmão não parece conferir pior prognóstico, excepto nos que recebem terapêutica adjuvante com corticóides.

Os autores apresentam dois casos de doentes com infecção VIH e imunossupressão avançada, admitidos na unidade de cuidados intensivos por insuficiência respiratória. Em ambos houve isolamento de Pneumocystis jirovecii no lavado broncoalveolar. Apesar da terapêutica instituída ambos vieram a falecer. A biópsia pulmonar post mortem mostrou, nos dois casos, a presença de Pneumocystis e inclusões por citomegalovírus. Perante este achado tecem-se algumas considerações sobre o papel do citomegalovírus como agente de pneumonia na SIDA e sobre o seu significado como co-infectante na pneumocistose, sobretudo nos casos de falência terapêutica.

Rev Port Pneumol 2008; XIV (1): 151-157

Palavras chave:
Citomegalovírus
pneumonia
VIH
Abstract

Cytomegalovirus is capable of causing disease in immunocompromised patients. In people infected by the Human Immunodeficiency Virus (HIV) it becomes an important agent when there is advanced immunosupression. Its role as a pulmonary pathogen in these patients has been questioned. In the case of pneumocystosis the presence of Cytomegalovirus doesn’t seem to worsen prognosis, except in cases where corticosteroids are used.

Authors present two cases of patients with HIV infection and advanced immunosupression who were admitted in the intensive care unit for respiratory failure. In both Pneumocystis jirovecii was isolated from bronco-alveolar lavage. Despite of therapy both patients died from refractory hypoxemia. Pulmonary biopsies performed post mortem revealed presence of Pneumocystis and Cytomegalovirus inclusion bodies. Considering this finding the role of Cytomegalovirus as a cause of pneumonia in AIDS is discussed, highlighting its impact on the outcome of patients with pneumocystosis, especially in cases of therapeutic failure.

Rev Port Pneumol 2008; XIV (1): 151-157

Key words:
Cytomegalovirus
pneumonia
HIV
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Copyright © 2008. Sociedade Portuguesa de Pneumologia/SPP
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