Nonspecific radiographic manifestations of cytomegalovirus infection in 4 HIV-positive adults – diagnosis through transbronchial biopsy

We report on 4 HIV-positive adult patients who presented (over a 2-year period) with clinically significant cytomegalovirus (CMV) pneumonia requiring transbronchial biopsy for diagnosis. The patients were not on antiretroviral therapy. Clinical findings were nonspecific, sputum samples were negative, blood test results were non-contributory, and empirical treatment had failed. Radiological findings were extensive but nonspecific. Three of the 4 patients were co-infected with Pneumocystis jirovecii (PJP) pneumonia, further confounding the radiological diagnosis.