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Giant cell pneumonia in a leukemic child in remission: a case report
1Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Abstract:
Giant cell pneumonia is a rare and uncommon type of lung infection developing as a complication of measles, especially in immunocompromised patients, whether their immune systems are affected primarily or whether they have acquired immune defects. As well as being uncommon, it is also atypical because of absence of the characteristic rash and of absent or low antibody titers against measles in most of the cases. It is known that cellular immunity is more important than humoral immunity in the host response to measles, so hypogammaglobulinemic patients with normal cellular immunity usually recover uneventfully from measles and also have the characteristic rash. We report a case with giant cell pneumonia that was confirmed by postmortem histopathological examination. We especially want to point out that even in the absence of rash, with the clinical and radiological features of pneumonia, measles should be considered in a patient, whether in remission or not, receiving immunosuppressive treatment.
Insights
Giant cell pneumonia is a rare measles complication in immunocompromised individuals. Diagnosis is challenging due to atypical presentations like absent rash, necessitating consideration even with pneumonia symptoms.
Area of Science:
- Infectious Diseases
- Immunology
- Pathology
Background:
- Giant cell pneumonia (GCP) is a rare lung infection, often a complication of measles.
- It predominantly affects immunocompromised patients with primary or acquired immune defects.
- GCP can present atypically, lacking the characteristic measles rash and typical antibody titers.
Observation:
- The case involved a patient with giant cell pneumonia confirmed by postmortem histopathology.
- The patient did not exhibit the typical measles rash.
- Clinical and radiological findings were consistent with pneumonia.
Findings:
- Cellular immunity plays a crucial role in measles response, more so than humoral immunity.
- Patients with hypogammaglobulinemia and intact cellular immunity typically recover from measles with a rash.
- Atypical presentations of GCP, including absence of rash, can occur in immunocompromised individuals.
Implications:
- Measles should be considered in the differential diagnosis of pneumonia in immunocompromised patients, even without a rash.
- This highlights the importance of considering measles in immunosuppressed patients presenting with pneumonia, regardless of typical exanthem.
- Postmortem histopathological examination is crucial for confirming giant cell pneumonia in atypical cases.
