This case demonstrates acute extensive bilateral ground glass opacities in an immunocompromised patient, with differentials including Pneumocystis jirovecii and CMV, with the latter favored given the elevated CMV viral load. 

CMV PCR/LOAD
CMV DNA PCR          DETECTED                         
CMV LOAD(Copies/mL)  76                              
Log10 (Copies/mL)    1.88                          

Cytomegalovirus pneumonia is a type of viral pneumonitis and occurs due to infection with cytomegalovirus (CMV), which is a member of the Herpetoviridae family.

CT findings are non-specific and diverse and have been described without distinction between AIDS and non-AIDS patients. Commonly described findings include:

• mixed alveolar-interstitial infiltrative opacification
  • ground-glass opacities 
    • a relatively common feature 
• small pulmonary nodules 
  • nodules tend to have bilateral symmetrical distribution and involve all zones 
• confluent consolidation 
  • may be more marked towards the lower lobes 
• bronchiectasis 
• interstitial reticulation: without air space opacification 

The imaging differential is broad but in the immunosuppressed population consider:

• Pneumocystis jirovecii pneumonia 
  • may contain (not always) small intrapulmonary cysts on CT 
  • may have a more apical distribution 
  • the ground glass changes may be more homogeneous 
• other forms of viral pneumonitis