Severe cytomegalovirus infections in immunocompetent patients at admission as dengue mimic: Successful treatment with intravenous ganciclovir

Abstract

Cytomegalovirus (CMV) infection is associated with adverse clinical outcomes in immunosuppressed persons. The incidence and association of CMV reactivation with adverse clinical outcomes in critically ill persons lacking evidence of immunosuppression at ICU admission has received great attention in the practice of critical care medicine. Critically ill patients in ICU who had associated risk factors such as mechanical ventilation, severe sepsis, or blood transfusion are more prone to CMV activation, which in turn led to increased mortality and morbidity in terms of increased ICU stay, longer duration of mechanical ventilation, and higher rates of nosocomial infections. However, severe CMV as initial presentation mimicking dengue infection is rare. We recently came across seven cases with positive CMV serology at ICU admission, which we discuss in the light of current literature.

Cytomegalovirus disease in immunocompetent adults

“…These agents may have major side effects, including myelosuppression and potential carcinogenicity. However, untreated CMV disease is associated with considerable morbidity and mortality, and published case studies and reviews provide consistent case‐based evidence of rapid clinical improvement after commencement of therapy in this clinical setting 3 , 11 , 17 , 21 . ‐ 23 Furthermore, a recent study found ganciclovir to be a safe and effective treatment for CMV‐associated pneumonia in immunocompetent children 24 .…”

“…Third, certain presentations of CMV disease strongly mimic other diseases, potentially causing diagnostic confusion and delay in diagnosis. Indeed, case studies have documented initial misdiagnoses of colon carcinoma, 14 ischaemic colitis, 15 inflammatory bowel disease, 16 dengue fever 17 and lung cancer, 18 among others.…”

A rare case of cytomegalovirus parotitis and possible encephalitis in an immunocompetent child

“…As most of the CMV infections in immunocompetent patients are self-resolving, the evidence for the use of these drugs in immunocompetent patients is lacking. Tirumala et al reported several cases of CMV infection mimicking dengue fever in immunocompetent patients, successfully treated with intravenous ganciclovir (8). Nangle et al, reported 3 cases of immunocompetent adults with severe CMV infection successfully treated with valganciclovir.…”

Cytomegalovirus infection in immunocompetent adults: Is observation still the best strategy?

“…Five of the 6 patients who received anti-CMV therapy survived, while majority (14/18, 78%) of patients who did not receive therapy died. There are several published case reports and reviews that highlight the significant mortality and morbidity associated with untreated CMV infection in immunocompetent patients with rapid clinical improvement after anti-CMV therapy [ [7] , [8] , [9] , [10] , [11] , [12] ].…”