Fatal cytomegalovirus pneumonia in a critically ill patient with COVID-19

Abstract

Coronavirus disease 2019 (COVID-19) can cause severe lymphopenia and respiratory failure requiring prolonged invasive mechanical ventilation (MV). COVID-19 patients with severe lymphopenia or respiratory failure are at risk of developing secondary infections. Here, we present the needle autopsy findings of a critically ill patient with COVID-19 who required reintubation and prolonged MV, and eventually died of secondary cytomegalovirus (CMV) pneumonia. This case highlights the potential risk of long-term steroid use and the need for routine monitoring for CMV infection in critically ill patients with COVID-19.

Keywords: COVID‐19; Co‐infection; corticosteroid therapy; cytomegalovirus pneumonia; lymphopenia.

Figure 1

(A) Chest computed tomography scan at the time of positive cytomegalovirus (CMV) antigenemia showing bilateral ground‐glass opacity with consolidation. Pneumomediastinum is also present. (B) Immunohistochemical stain of a lung biopsy specimen showing a positive stain for CMV. Scale bar: 50 μm.