Unexplained Fever With Progressive Dyspnea

Abstract A 29-year-old African American Ohioan female presented with fever, shortness of breath, dry cough, and severe pleurisy. Her medical history included metastatic desmoplastic small round cell tumor with peritoneal carcinomatoses. She was admitted to the intensive care unit for acute hypoxic respiratory failure, culture negative neutropenic fever, diarrhea and undifferentiated shock. Infectious workup was unrevealing with negative blood culture, respiratory virus PCR, viral hepatitis, stool Clostridioides difficile toxin, enteric panel PCR, Legionella urine antigen, and Histoplasma antigens. Cytomegalovirus (CMV) reactivation with multiorgan involvement (colitis, hepatitis, and pneumonitis) was considered. CMV PCR resulted at 3,445,108 IU/mL. Upon initiation of antivirals, her hypoxia, diarrhea, and hepatitis resolved along with a decline in CMV viremia. The combination of desmoplastic small round cell tumor with a complication of CMV pneumonitis has not been previously reported. Clinical CMV disease is uncommon in patients with a solid tumor malignancy; however, it should be considered in the appropriate clinical context.