# A Challenging Case of Viral Pneumonia in the COVID-19 Pandemic Era

## TL;DR

This paper presents a case where a patient with symptoms resembling COVID-19 was actually infected with cytomegalovirus (CMV), highlighting the importance of considering other viruses during the pandemic.

## Contribution

The novelty lies in identifying CMV as a potential mimic of SARS-CoV-2 infection in an elderly immunocompetent patient.

## Key findings

- A 73-year-old immunocompetent woman presented with symptoms similar to COVID-19 but tested negative for SARS-CoV-2.
- High CMV viral load was detected, and the patient improved with valganciclovir treatment.
- The case emphasizes the need to consider non-COVID-19 viral etiologies in patients with pneumonia and cytopenia.

## Abstract

Cytomegalovirus (CMV) is a DNA virus that can cause widespread, severe infection in immunocompromised patients. While CMV usually leads to a subclinical infection in immunocompetent individuals, it can rarely cause severe disease in this population. The SARS-CoV-2 virus is an RNA virus and part of the Coronaviridae family. SARS-CoV-2 led to the COVID-19 (coronavirus disease 2019) pandemic. Even though COVID-19 usually presents with signs and symptoms of upper respiratory tract infection in younger adults, viral pneumonia, cytopenia, and neurological symptoms become more apparent with increasing age. Herein, we describe an immunocompetent 73-year-old female patient in whom oxygen demand and pancytopenia developed during hospitalization for post-ablation inguinal access site infection. The thorax CT revealed viral pneumonia, but two subsequent SARS-CoV-2 polymerase chain reaction (PCR) tests and a viral respiratory multiplex PCR panel were negative. The CMV viral load was high in the blood sample, and the patient responded to valganciclovir treatment. Although SARS-CoV-2 should be evaluated in patients with viral pneumonia and cytopenia, other viral etiologies mimicking SARS-CoV-2 infection, such as CMV, should not be overlooked in the era of the COVID-19 pandemic.