[75-year-old man with rapid deterioration of his general condition]

A 75 year old man was hospitalized because of rapid deterioration of his general condition, weight loss, night sweat and subfebrile temperature. The patient presented with severely reduced general condition, tachyarrythmia with previously known atrial fibrillation. Laboratory investigations revealed among others a moderately increased CRP-value, normal sedimentation rate and, initially, a normal white cell count. The differential diagnosis included neoplastic and infectious diseases (i.e. endocarditis, tuberculosis), endocrinopathies (i.e. thyreoditis) and general inflammatory or rheumatic diseases. An initially increased CMV-IgM-titer, a rising anti CMV IgG-titer and gradually developing atypical lymphocytosis in particular suggested diagnosis of severe CMV-infection. The diagnosis was confirmed by PCR positive for CMV-DNA in blood. The course of a CMV-primary infection may develop from asymptomatic infection over a mononucleosis-like syndrome to disseminated CMV-infection with multi organ involvement.