Cytomegalovirus pneumonitis in an HIV positive patient

A 64-year-old newly diagnosed retroviral positive, unmarried, male with a CD4 count 77 cells/mm³ presented with productive cough, fever, wheezing and pleuritic type chest pain for 5 days duration. On examination he had B/L rhonchi, crepitations. His baseline investigations and CXR was normal. Pneumocystis jirovecii pneumonia prophylaxis, isoniazid prophylaxis and antiretroviral treatment (ART) was started. Within first week of starting ART, his respiratory symptoms got worsened. Repeat investigations had no significance other than the rising CMV quantitative DNA PCR from 2290 IU/ml to 2.03×104 IU/ml. Repeat CXR revealed right side pleural effusion with underling collapse and consolidation. HRCT was compatible with CMV pneumonitis. Mild pericardial effusion in the 2D ECHO. Patient was improved with intravenous Ganciclovir. Here, we present a possible case of CMV pneumonitis, as it should be considered in the differential diagnosis of patients with rising CMV quantitative DNA PCR even with a higher CD4 count.