Introduction: Cytomegalovirus (CMV) infections can cause multisystem involvement with many clinical manifestations. We report a rare case of CMV-related multisystem disorder in an immunocompetent patient with cardiac tamponade, pneumonia, pancytopenia and diarrhea, who was later diagnosed with monoclonal gammopathy of undetermined significance (MGUS).
Description: A 41-year-old female with no significant medical history presented with shortness of breath, fatigue, and diarrhea. Physical exam revealed elevated JVP, distant heart sounds, and pulsus paradoxus. Lab studies revealed pancytopenia and elevated CMV DNA levels. Echoand chest CT revealed cardiac tamponade and bilateral patchy pneumonia. The patient underwent pericardial drain placement. Bronchoscopy, bronchoalveolar lavage (BAL), and transbronchial biopsy were non-diagnostic. Respiratory pathogen PCR and cultures were negative. Cardiac MRI showed subacute myopericarditis and MRI of the abdomen revealed hepatosplenomegaly. Bone marrow biopsy showed findings consistent with IgM-MGUS. The patient’s clinical status improved with intravenous ganciclovir therapy. Follow-up CT chest showed significant improvement in the bilateral pneumonia.
Discussion:
Discussion: CMV infection may cause severe multisystem involvement, even in immunocompetent individuals with underlying hematological disorders. It is unclear whether the severe CMV infection contributed to the patient's MGUS. It is postulated that chronic antigenic stimulation, including viral infections, may contribute to the development and persistence of MGUS. However, further studies are needed to establish a causal relationship between CMV infection and MGUS.
In the diagnosis of CMV-related multisystem disorder, it is important to rule out other infectious and non-infectious causes of the patient's clinical presentation, such as other viral infections, connective tissue disorders, and malignancies. Elevated CMV DNA levels, along with a high index of suspicion can help in establishing the diagnosis.
Conclusion: CMV-related multisystem disorder should be considered in the differential diagnosis of patients presenting with a constellation of symptoms, particularly in those with underlying hematological disorders. Early diagnosis and appropriate management can significantly improve clinical outcomes.
