Cytomegalovirus infection in solid malignancies

Introduction: Cytomegalovirus (CMV) infection is very common, although its manifestation as disease occurs usually in the setting of immunosuppression. It is usually seen in hematological malignancies and in post-transplant recipient patients. Data about CMV reactivation in solid malignancies are limited. Materials and Methods: This was a retrospective analysis of adult patients (from the past 10 years of clinical records) with various solid malignancies, who had CMV deoxyribonucleic acid (DNA) positivity and had varied clinical presentation. Results: Of total 73 adult patients of solid malignancies who had been tested for CMV DNA (by real-time polymerase chain reaction [RT-PCR]) with a detection limit of 150 copies/ml), 30 patients had at least one instance of CMV DNA positivity. Of them, we were able to obtain detailed records of 17 patients, who had CMV DNA positivity with clinical manifestations. Fever was the most common symptom in 88% of patients. CMV DNA copy numbers in these patients ranged from 250 to 1,490,000 copies/ml (by RT-PCR). Twelve of the 17 patients (71%) had positive tests for other microbes (based on culture testing) besides the positive CMV test. Ten of 17 (59%) patients were treated with ganciclovir and 7 patients responded to treatment. Seven patients (3 treated with ganciclovir and 4 remained untreated) died during the hospital course. Ten patients recovered (7 treated with ganciclovir and 3 remained untreated, with only monitoring of CMV DNA levels) of their acute illness. Conclusion: CMV infection and its manifestation in patients with solid malignancies is probably underdiagnosed. Given the high morbidity and mortality in these patients (with or without co-infections), it is very important to suspect and treat CMV reactivation.