Enlarging ¹⁸F-FDG-Avid Solitary Pulmonary Nodule: A Distinctly Unusual Presentation of Cytomegalovirus Infection in a Patient Receiving Chemotherapy

Rapidly growing lung lesions, particularly in immunocompromised patients, invoke consideration of an infectious etiology. Aspergillomas, for example, can appear as round nodules with soft tissue attenuation, often associated with cavitation, and are variably 18F-FDG avid. In contrast, cytomegalovirus, which may also evidence 18F-FDG uptake, typically manifests as ground-glass opacities, symmetrically distributed small pulmonary nodules, or confluent consolidations, with lower lobe predilection. We describe a patient treated for lymphoma presenting with a solitary enlarging FDG-avid lung nodule, which was determined on resection to be focal cytomegalovirus infection, a distinctly uncommon presentation of this pathogen, more typical of fungal or mycobacterial disease.