Congenital cytomegalovirus pneumonia presents as pleural effusion in infancy.

Cytomegalovirus (CMV) infection is one of the most common congenital infections. We present a case of an infant who presented with respiratory distress since birth with a normal antenatal history. The infant had bilateral pleural effusion. He was malnourished with a small head. Chest auscultation revealed bilateral diffuse crepitation. The chest radiograph showed diffuse haziness with the interstitial pattern. Contrast-enhanced CT of the thorax showed diffuse areas of ground glass opacities with peribronchial thickening and patchy atelectasis in bilateral lower lobes. Detailed evaluation showed positive IgM CMV antibodies with >1000 copies/mL of CMV on urinary PCR. Hearing evaluation revealed bilateral moderate hearing loss.This case emphasises that CMV may present as pneumonitis at birth. Early diagnosis and treatment are of paramount importance in such cases, as it can prevent permanent end-organ damage.