Cytomegalovirus was demonstrated by direct immunofluorescence with monoclonal antibodies and/or culture in 21 of the 59 BALs studied. Likewise, herpes simplex virus was identified in five specimens and parainfluenza type 3 was identified in one. Intranuclear viral inclusions were seen cytologically in only two cases, one of cytomegalovirus and one of herpes. In only one patient who had treated acute myelogenous leukemia was cytomegalovirus believed clinically to be a cause of progressive pneumonia. In 13 cases, cytomegalovirus was isolated from AIDS patients with Pneumocystis pneumonia, but clinically it was not responsible for disease.
In four patients (one each with malnutrition, Hodgkins disease, heart-lung transplant, and acute myelogenous leukemia) either biopsy specimen or autopsy failed to show cytomegalovirus as a pathogen. A heart transplant patient with Pneumocystis pneumonia and cytomegalovirus cultured from a BAL recovered after therapy for Pneumocystis; blood, throat, and urine cultures were negative for cytomegalovirus. The remaining two patients, one with multiple myeloma and a drug reaction, the other with coccidioidomycosis complicating corticosteroid-treated polymyositis, had no clinical evidence of cytomegalovirus pneumonia.