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Lung India ; 39(SUPPL 1):S157, 2022.
Article in English | EMBASE | ID: covidwho-1857324


Background: 70-90 % of the adult population carries latent cytomegalovirus (CMV), which may be reactivated by inflammation and immune suppression. CMV reactivation has been seen in up to one-third of critically ill patients, and is associated with worse clinical outcomes. Here, the authors present two challenging cases, wherein the management of severe COVID-19 disease was complicated by CMV pneumonia. Case Reports: Our patients presented with severe COVID-19 pneumonia with acute respiratory distress syndrome and were admitted in the intensive care unit (ICU). The patients received immunosuppressive therapy, either tocilizumab or methylprednisolone pulse therapy. Both the patients had a prolonged hospital stay, and showed an initial improvement followed by clinical deterioration, with recurrence of fever, worsening respiratory failure, and development of consolidations on CT thorax. A thorough work up for opportunistic infections revealed CMV infection. Both patients were treated with intravenous Ganciclovir and showed marked improvement. Discussion: The use of steroids and other immunomodulatory therapies in the treatment of severe COVID-19 disease, along with immune suppression caused by severe COVID-19 itself, predisposes patients to reactivation of CMV. Furthermore, CMV reactivation is associated with a longer ICU length of stay, prolonged mechanical ventilation, increased risk of secondary infections, and mortality. Conclusion: These cases highlight the importance of considering CMV disease as a differential diagnosis in critically ill patients with COVID-19 with unexplained worsening, especially in the setting of immunomodulatory therapies, as early treatment may prevent adverse clinical outcomes and mortality.