Abstract

A 28-year-old male patient presented to the emergency department with cough, shortness of breath, and white, viscous sputum. Thoracic computed tomography demonstrated diffuse reticular and ground-glass opacities in both lungs. Empirical intravenous (IV) piperacillin-tazobactam and ciprofloxacin therapy was initiated. Laboratory evaluation revealed an HIV RNA PCR test result of 824 954 copies/mL, a cytomegalovirus (CMV) DNA level of 10 088 copies/mL, and a CD4+ count of 81 cells/mm3. Trimethoprim-sulfamethoxazole was initiated for suspected Pneumocystis jirovecii pneumonia (PCP). No pathogenic microorganisms were identified in cultures. The patient was transferred to the intensive care unit on the seventh day of hospitalization due to lack of clinical improvement and worsening respiratory distress, and IV ganciclovir was started. During ganciclovir therapy, CMV DNA levels measured one week apart were 230,771 copies/mL and 420,869 copies/mL. No additional CMV-related foci were identified. The patient’s condition improved rapidly with ganciclovir, and he was discharged after completing 30 days of therapy. This case was presented to draw attention to possible CMV pneumonia in a patient with newly diagnosed HIV infection.