Ganciclovir therapy and supportive care led to gradual improvement in oxygenation in a 72-year-old immunocompetent man with severe CMV pneumonitis refractory to standard therapies.
Case Report (n=1)
CMV pneumonitis can occur in immunocompetent hosts and should be considered in refractory pneumonia, with antiviral therapy potentially aiding recovery.
Abstract Introduction Cytomegalovirus (CMV) pneumonitis is classically associated with immunocompromised patients, including transplant recipients or those with HIV or prolonged immunosuppression. Its occurrence in immunocompetent adults is exceedingly rare and often leads to diagnostic delay. We present a case of severe CMV pneumonitis in an immunocompetent patient with progressive hypoxemia despite standard therapies. Case Presentation 72-year-old man with coronary artery disease (status post CABG and PCI), left carotid stent, COPD, chronic interstitial lung disease, and obesity presented with right-sided weakness, numbness, and visual changes. During hospitalization, he developed worsening shortness of breath and hypoxia. Imaging revealed bilateral pulmonary infiltrates, and initial management targeted multifocalpneumonia and COPD exacerbation with antibiotics and corticosteroids (methylprednisolone 40 mgIV every 6 hours for 5 days, followed by a gradual taper). Despite therapy, his respiratory status deteriorated, requiring NIV with HFNC. COVID-19 and influenza PCR tests were negative. CTA chest ruled out pulmonary embolism. Urine pneumococcal and Legionella antigens were negative, and blood, sputum, and BAL cultures showed no growth. Bronchoscopy demonstrated multinucleatedgiant cells, raising suspicion for a viral etiology. CMV PCR and serology (IgM and IgG) were positive,confirming CMV pneumonitis. The patient had no history of immunosuppression or HIV infection.Given his worsening respiratory failure, ganciclovir was initiated after infectious disease consultation.His oxygenation gradually improved with supportive care and antiviral therapy. Discussion This case illustrates that CMV pneumonitis can occur in immunocompetent hosts, particularly in the setting of critical illness. The diagnosis should be considered when pneumonia fails to improve with standard antimicrobial or steroid therapy. While the role of antivirals such as ganciclovir remains uncertain in immunocompetent patients, treatment may be warranted in severe or progressive cases. Conclusion CMV pneumonitis, though rare in immunocompetent individuals, should remain in the differential diagnosis of refractory pneumonia. Early recognition and consideration of antiviral therapy can be crucial for recovery in severe presentations. This abstract is funded by: None
Barham et al. (Fri,) conducted a case report in CMV pneumonitis (n=1). Ganciclovir was evaluated. Ganciclovir therapy and supportive care led to gradual improvement in oxygenation in a 72-year-old immunocompetent man with severe CMV pneumonitis refractory to standard therapies.