Concurrent Pneumocystis carinii and cytomegalovirus pneumonia after autologous peripheral blood stem cell transplantation

A 46-year-old woman developed concurrent CMV and Pneumocystis carinii pneum onia (PCP) 140 days after autologous peripheral blood stem cell transplanta tion (APBSCT) for AML, She was seropositive for CMV before undergoing APBSC T and had required prednisone for immune thrombocytopenia and allergic derm atitis for 9 weeks prior to the onset of pneumonia, She had also been recei ving PCP prophylaxis with pentamidine aerosol every month for 3 months befo re developing symptoms. The pneumonia was complicated by severe hypoxia, re quiring ventilator support and pneumothorax requiring chest tube thoracosto my, She recovered following treatment with trimethoprim-sulfamethoxazole (T MP-SMX), prednisone, gancyclovir and intravenous immunoglobulin, Although t he overall incidence of severe CMV disease is low after APBSCT, preventive measures such as surveillance culture and secondary prophylaxis with gancyc lovir may be warranted in patients whose cellular immune response is furthe r compromised by corticosteroid use or other factors.