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Cytomegalovirus (CMV) is known to cause fatal pneumonia in human immunodeficiency virus (HIV) infected children. There is a paucity of literature on pediatric HIV and CMV coinfection in India. We describe six cases of severe pneumonia in infants infected with HIV. Four of these infants also had CMV coinfection, detected by urine polymerase chain reaction. There was a lack of antenatal and postnatal care in all cases. All four infants with CMV coinfection succumbed to severe acute respiratory distress syndrome, whereas the other two survived. In conclusion, a high index of suspicion for CMV should be kept in HIV-infected infants presenting with severe pneumonia, although CMV pneumonia is difficult to diagnose with certainty. The important role of antenatal care for mothers with HIV infection, as well as postnatal care for babies born to HIV-positive mothers, cannot be overstated.

Background: Lymphocytic interstitial pneumonia (LIP) is a rare disorder causing diffuse involvement of the lung parenchyma, including cystic changes. It is generally associated with autoimmune diseases in adults and human immunodeficiency virus infection in children. Concurrent LIP with pulmonary tuberculosis (TB) is rare and has not been reported in the pediatric population. Clinical Description: An 8-month-old infant who was recently diagnosed with miliary pulmonary TB and on antitubercular treatment presented with fast breathing for 2 days. Salient examination findings were tachypnea, with oxygen saturation of 84% in room air. High-resolution computed tomography of the chest showed diffuse involvement of both lungs with bilateral cystic changes. Histopathological examination of a lung biopsy specimen was consistent with LIP. Management: First-line antitubercular therapy was continued as per the national guideline, and methylprednisolone pulse was administered for 3 days followed by maintenance prednisolone for 8 weeks. The child responded well clinically and was kept under close follow-up. Radiological improvement became apparent at 15-month follow-up. Conclusion: Presence of diffuse cystic lung disease in pulmonary TB should raise suspicion for LIP. Lung biopsy is diagnostic and should be considered in such cases.