Cytomegalovirus Pneumonia in Patients with Severe COVID-19

Severe pneumonia accounts for 15% of the total severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, and the affected patients require hospitalization and oxygen support. In addition, 5% of patients with severe coronavirus disease 2019 (COVID-19) experience acute respiratory distress syndrome and sepsis, which contributes to the high mortality rate. Moreover, the risk of severe COVID-19 increases with age and is the highest among elderly people over 70 years of age. Notably, these pneumonia cases can be attributed to the reactivation of latent cytomegalovirus (CMV). We hereby report two cases of patients with COVID-19 who required prolonged mechanical ventilation and were later diagnosed with secondary CMV pneumonia. These cases support the theory that in some patients with severe COVID-19, there is a possibility of CMV reactivation, contributing to the disease's severity and pathogenesis. These cases also highlight the risk involved in using steroids for a long time and the requirement of routine evaluation for CMV infection in patients with COVID-19 who require prolonged mechanical ventilation or have difficulty weaning off from the ventilator support.