Concurrent culprits: Deciphering CMV co-infection in persistent COVID-19 scenarios

Background COVID-19 has an uncharacteristic course in immunodeficient patients, often contributing to diagnostic and therapeutic difficulties and the reactivation of latent infections. Objective To describe the clinical course and therapeutic outcomes in immunocompromised patients with persistent COVID-19 who were found to have concurrent cytomegalovirus (CMV) reactivation, and to assess the potential impact of anti-CMV therapy on SARS-CoV-2 clearance. Material and methods Four different cases of COVID-19 pneumonia and immune disorders were evaluated, and the intended effect was not achieved, despite multidirectional treatment aimed at SARS-CoV-2. This prompted further virological research to investigate the features of CMV reactivation. Results Multidirectional treatment of COVID-19 in immunodeficient patients did not contribute to viral eradication. In all patients, high CMV viremia was observed with the use of ganciclovir/valganciclovir, which suppressed CMV replication and contributed to the elimination of SARS-CoV-2. Conclusions This case series highlights the complex relationship between SARS-CoV-2 and CMV, emphasizing the need for a comprehensive virological evaluation of persistent COVID-19 cases. As the global medical landscape has grappled with the evolving challenges of the pandemic, incorporating such multifaceted clinical insights remains paramount.