THE GREAT MIMICKER: WHY A THOUGHTFUL APPROACH TO CYTOMEGALOVIRUS IS CRUCIAL

• Dr. Leona R. Veltric

  Department of Infectious Diseases, Royal College of Surgeons in Ireland, Dublin, Ireland

  Author

• Dr. Sandeep K. Maretla

  Division of Clinical Microbiology, Christian Medical College, Vellore, India

  Author

• Dr. Carla D. Inveren

  Department of Medical Sciences, University of Padua, Italy

  Author

In the vast world of infectious diseases, few pathogens are as enigmatic as Cytomegalovirus (CMV). This ubiquitous betaherpesvirus is a master of disguise, capable of causing a dizzying array of clinical pictures. In most healthy people, it passes like a silent ghost, leaving no trace of its visit. But for those with developing or weakened immune systems—newborns and transplant patients, for example—CMV can be a devastating force, causing severe, disseminated, and life-threatening illness. Congenital CMV (cCMV) is the most common infection passed from mother to child before birth and a primary non-genetic reason for permanent hearing loss and long-term neurodevelopmental challenges. The true challenge of CMV lies in its ability to mimic a multitude of other conditions. Its symptoms frequently overlap with other infections, as well as genetic, metabolic, and systemic disorders, making it a true "great mimicker" in clinical medicine. This diagnostic puzzle demands a careful and comprehensive approach from any physician. Getting the diagnosis right is everything; it shapes treatment, guides conversations with families, and sets the course for a patient's entire life. This review walks through the story of CMV—from its complex biology to the diverse ways it presents in our patients—and makes the case for why a thoughtful differential diagnosis is critical to unmasking the true culprit when CMV is found at the scene.

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