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( Patrick James Co ),( Denise Francesca Esguerra ),( Ma Fe Tayzon ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Primary Cytomegalovirus infection has been implicated and well-reported in immunocompromised hosts, particularly in patients with HIV, organ transplant recipients, and those with underlying malignancies. Among immunocompetent individuals, CMV infections were usually an incidental fi nding whenever IgM and IgG antibody determinations were included in the work-up of a patient presenting with fever and rash. More commonly we see IgG positivity which means that past CMV infections are usually mild enough to pass as ordinary viral infections. This is a case of acute CMV infection in an immunocompetent, young female who presented with prolonged fever. The following diagnostics were done as work-up for fever of unknown origin: blood, urine and stool culture; malarial smears; serologic tests for EBV, Toxoplasma and CMV; monospot and anti-nuclear antibody tests; CD4 and CD8 determinations. Serum CMV IgM positivity was the only signifi cant fi nding hence all subsequent diagnostics included CMV determinations. When CT scan of the chest and abdomen showed pulmonary infi ltrates and some abdominal lymphadenopathies, bronchoscopy was done and BAL examinations included Legionella IFAT; Pneumocystis jirovecii and fungal cultures; PCR for M. tuberculosis, PCP and CMV, in addition to the usual routine cultures. Laparoscopy was conducted to obtain a mesenteric lymph node which was sent for TB and CMV PCR. After failure to respond to empiric broad spectrum antibiotic therapy, the patient continued to have intermittent moderate to high-grade fever, headache and progressive shortness of breath. Subsequently, CMV PCR was positive in serum, lymph node and BAL samples, pointing to an uncommon condition of primary CMV infection in a healthy young individual. Because of persistence of symptoms for more than three weeks of hospital stay, she was started on Valganciclovir 1.8 gm/day and was discharged improved with completion of antiviral therapy.
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