1307 - Rehabilitation Monitoring Uncovers Cytomegalovirus Infection in an Immunocompromised Patient

44-year-old female with acute myeloid leukemia (AML) on consolidation chemotherapy admitted for inpatient rehabilitation following prolonged hospitalization for neutropenic fever, septic shock, pseudomonal pneumonia/bacteremia, and respiratory failure.

Case Description:

Three months after induction and consolidation chemotherapy for AML, the patient presented with neutropenic fever and developed septic shock with hypoxic respiratory failure due to pseudomonal pneumonia/bacteremia, requiring ICU admission, vasopressors, and intubation. After stabilization, she was admitted to inpatient rehabilitation for critical illness myopathy, severe deconditioning and functional decline. She participated in three hours of multidisciplinary therapy daily. Early in her rehab stay, she developed persistent sinus tachycardia, initially attributed to AML. Upon further workup, a pleural effusion was found to be  exudative and non-infectious via thoracentesis, but her tachycardia persisted. Ongoing monitoring during therapy prompted further evaluation, revealing active CMV viremia. Targeted antiviral therapy with valganciclovir was initiated with resolution of her tachycardia. She made functional gains, progressing in mobility and self-care.

Discussions:

While tachycardia in malignancy is often linked to tumor burden or treatment effects, other causes such as infection or cardiopulmonary complications must be considered, especially in immunocompromised patients.1 This case highlights how vigilant rehab monitoring can reveal overlooked, treatable causes of vital sign changes, preserving both medical stability and functional gains. In this patient, persistent tachycardia during rehab was the earliest clue to CMV infection, not underlying AML or cardiopulmonary etiology. Prompt recognition allowed for timely initiation of antiviral therapy and therapeutic thoracentesis without interrupting functional recovery, additionally demonstrating the importance of interdisciplinary collaboration in rehabilitation to prevent return to acute care.

Conclusions:

In immunocompromised patients undergoing rehabilitation, new or persistent vital sign abnormalities should prompt thorough evaluation. Integrating careful medical oversight with therapy can ensure both timely treatment of illness and continued functional recovery.