Hypogammaglobulinemia Associated with Cytomegalovirus Pneumonia

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Abstract
Transient but profound hypogammaglobulinemia occurred during cytomegalovirus (CMV) pneumonia in a patient who developed striking declines in number of T lymphocytes. A66-year-old, female, human immunodeficiency virus-negative patient requiring long-term hemodialysis had normal serum immunoglobulin concentrations before the onset of CMV pneumonia (lgG, 1070–1470 mg/dl; 19A, 94–102mg/dl; IgM, 30–48 mg/dl). During the pneumonia episode, serum immunoglobulin concentrations wereprofoundly reduced (IgG, 440 mg/dl; 19A, 40 mg/dl; IgM, 25 mg/dl). Total lymphocytes declined from 3048/mm3 to 212/mm3 with reductions in CD4+CD45− lymphocytes (inducers of B cells) to 9% (nl, 24%–32%) and CD4+CD45+ lymphocytes (inducers of suppressor T cells) to 4% (nl, 14%–22%). CD8 lymphocytes were reduced to 5%(nl, 19%–31%). Asthe pneumonia resolved, serum immunoglobulinconcentrations returned to normal. This is one of the few reported instances of CMV infection apparently causing hypogammaglobulinemia.

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