Which histologic findings are characteristic of lung allograft viral infection?

Updated: Jun 06, 2019
  • Author: Aliya N Husain, MBBS, MD; Chief Editor: Philip T Cagle, MD  more...
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Answer

Answer

Viral infection

CMV infection can be diagnosed on H&E sections; however, immunohistochemistry for CMV antigens allows for earlier detection and treatment, especially in the first posttransplantation year (see the following image). Histologically, CMV is characterized by enlarged cells (cytomegaly) with single large basophilic intranuclear inclusions and a clear halo. Viral infections may also be diagnosed with serologic techniques or culture. Matching the CMV status (donor and recipient), widespread use of prophylaxis, and the monitoring of viral load with polymerase chain reaction (PCR) have significantly reduced the incidence of CMV pneumonitis in transplant recipients. Viral infection places patients at a higher risk of acute and chronic rejection and death.

Lung transplantation-related pathology. The image Lung transplantation-related pathology. The image reveals cytomegalovirus (CMV) infection by immunohistochemical (IHC) staining: Both enlarged nuclei and normal-sized infected nuclei stain positively. This feature is helpful when viral inclusions are not readily apparent on hematoxylin and eosin (H&E) stain. (IHC stain using antibody against immediate early antigen, 200x)

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