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Cytomegalovirus pneumonia in bone marrow transplant recipients: miliary and diffuse patterns.

Cytomegalovirus (CMV) pneumonia is a frequent complication of bone marrow transplantation. The clinical and pathologic features of 16 bone marrow transplant (BMT) recipients with histologic and/or cultural evidence of pulmonary CMV infections were reviewed. Two major morphologic patterns were observed. Five BMT recipients had a miliary pattern of pneumonia: multiple focal pulmonary lesions with extensive cytomegaly, often with localized necrobiosis, alveolar hemorrhage, fibrin deposition, and a neutrophilic response. These patients had a fulminant onset of respiratory failure, and at autopsy cytomegaly was evident in the spleen in all cases. Ten BMT recipients had interstitial pneumonitis with alveolar-cell hyperplasia, interstitial edema with mild to moderate lymphoid infiltrate, and diffusely distributed cytomegalic cells. Their respiratory disease had an insidious onset, and 2 of the patients recovered. Buffy-coat or bone-marrow cultures were positive for CMV in only 2 of 9 patients studied. Among the ...