The mortality of CMV pneumonia in renal transplant

location of focal infectious roc’2 As opposed to galhum, accumulation in normal bowel does not signfficantly affect imaging ofthe abdomen and pelvis. It can also identify extra-abdominal sites ofinfection as well; in one study, three patients had pneumonitis detected prior to the appearance of an abnormal chest roentgenogram 13 The “In-WBC scanning is performed by obtaining a leukocyte-rich fraction of blood and labeling it with “In oxine. The lipophilic chelating agent oxine carries the “In across the membranes ofcells to be labeled. The oxine then diffuses out of the cell while the “In binds to intracellular proteins. The use ofthis scan in the diagnosis ofrejection and CMV infection in renal transplant recipients has been described once previously. Abnormal lung uptake was observed in 13 of 14 patients with CMV infection in that study.’ One of these 13 patients with disseminated CMV infection had an abnormal “In-WBC scan and a normal chest roentgenogram. However, in contrast to our patient, he developed bilateral infiltrates soon thereafter. This case demonstrates the usefulness of the “In-WBC scan in the diagnosis ofCMV pneumonia in a renal transplant recipient with a normal chest roentgenogram. Such patients have infectious pneumonitis due to a variety of organisms, including Aspergillus and HSV.4 Cytomegalovirus may suppress T-cell immunity and cause neutropenia, and on this basis, may predispose to superinfections with Aspergillus. However, this patient was never neutropenic and had no tissue evidence for Aspergillus infection. Given his immediate improvement with ganciclovir and in the absence of treatment for Aspergillus, we believe it is virtually impossible that the isolated Aspergillus was a pathogen. Likewise, although HSV infection is common in renal transplant recipients, primary HSV pneumonia is rare.4 There was no tissue evidence for HSV pneumonitis, and it grew only from the washings, not the BAL. We believe the HSV culture resulted from upper airway contamination. The mortality of CMV pneumonia in renal transplant