Triple attack: Cytomegalovirus, mycobacterium avium complex and aspergillus co-infection presenting as a cavitary pulmonary lesion in a patient with human immunodeficiency virus

Abstract

Background

Opportunistic infections are a significant concern in immunocompromised patients, particularly those with human immunodeficiency virus (HIV). The diagnosis of these infections can be challenging due to overlapping clinical and radiological findings.

Case description

We report a rare case of triple co-infection by cytomegalovirus (CMV), Mycobacterium chimaera, and Aspergillus fumigatus causing pneumonia with a cavitary lesion in a 43-year-old HIV-infected female, non-adherent to antiretroviral therapy. Chest imaging revealed a left upper lobe cavitary lesion with ground-glass opacities. Serum CMV PCR was strongly positive. Bronchoscopic biopsy showed Aspergillus and focal CMV pneumonia, while post-discharge culture grew Aspergillus and Mycobacterium chimaera. The patient was treated with intravenous ganciclovir and voriconazole, then discharged on oral medications with plans for MAC treatment.

Conclusion

This case represents the first reported triple co-infection of its kind, particularly noteworthy given the patient's CD4 count above 50 cells/mm³ . It underscores the importance of comprehensive diagnostic workup and highlights the challenges in managing multiple opportunistic infections in severely immunocompromised individuals.