ADENOVIRUS PNEUMONIA IN LUNG-TRANSPLANT RECIPIENTS

Although Adenovirus (ADV) pneumonia has been documented in bone marrow , kidney, and liver transplantation recipients, it has only been spora dically reported in lung transplantation recipients. Among our 308 lun g transplantation recipients, we identified four who developed ADV pne umonia. Formalin-fixed paraffin-embedded biopsy and autopsy specimens on all cases were studied by routine histology, immunohistochemistry ( IHC), and by in situ hybridization (ISH) for evidence of ADV, and the results were correlated with the patients' clinical progression. Three of the four patients were children, and all four had a progressive an d rapidly fatal course within 45 days posttransplantation. The lungs s howed necrotizing bronchocentric pneumonia with tendency to spread dif fusely to produce alveolar damage and organizing pneumonia. The occurr ence of this rapidly fatal ADV pneumonia mainly affecting the pediatri c population, early in the posttransplantation course, suggests that t he infection is primary to the recipient with ADV either originating a nd reactivating in the donor lung or acquired from the upper respirato ry tract of the recipient. The characteristic smudgy intranuclear incl usions of ADV, as well as IHC and ISH positivity, were observed in the lungs of all autopsies. Antemortem biopsy demonstration of ADV by inc lusion formation, IHC, and ISH was observed in two patients. In anothe r patient, antemortem ADV was shown only by ISH, and the recognition o f inclusions was made difficult by coexistent CMV infection. Although IHC and ISH may have the potential for detecting early infection, reco gnition of the characteristic clinical setting with necrotizing bronch ocentric pneumonia and smudgy intranuclear inclusions should alert one to the diagnosis of ADV pneumonia. Copyright (C) 1995 by W.B. Saunder s Company