Disseminated CMV Presenting as Pericardial Effusion with Tamponade Physiology

Introduction. Cytomegalovirus (CMV) is a double stranded DNA virus best known for its detrimental congenital transmission of infection. We present a rare case of disseminated CMV in an immunocompromised lupus patient. Case Description. The patient is a 38 year old female with a past medical history pertinent for learning disability, depression, and anemia who was admitted to the hospital for palpitations. On admission, the patient's temperature was 100℉ and she was tachycardic. Physical examination was pertinent for diaphoresis, mild distress, and diminished heart sounds. Cat Scan Angiography of the chest demonstrated a large pericardial effusion with tamponade physiology and the patient was taken urgently for pericardial window. Pathology of the pericardium showed fibrinous pericarditis but no malignancy. The patient’s course was complicated by newly diagnosed lupus requiring initiation of mycophenolate and dialysis. Plagued by persistent fevers, thrombocytopenia, and elevated liver enzymes despite broad spectrum antibiotic use, CMV serology was ordered. Over a million copies of CMV were detected by PCR and IV Valganciclovir was initiated. Discussion. This case demonstrates the importance of maintaining broad differentials for fever of unknown origin. CMV is usually an asymptomatic infection, with around half the population of the United States being seropositive for the disease. Patients with lupus can often be misdiagnosed with lupus flare because disseminated CMV presents with similar symptoms. Patients who are immunocompromised face risk of latent reactivation and swift diagnosis of disseminated CMV is essential to implement treatment and prevent long-term consequences.