A Man with Dyspnea, Proximal Muscle Weakness, and Hypoxemia

His myasthenia gravis had been managed with prednisone and mycophenolate mofetil. After hospital admission, progressive pancytopenia with hepatocellular injury developed. The multisystem involvement suggested an opportunistic infection related to profound T-cell dysfunction; viral testing and biopsy of the tongue ulcer (Figure 1) confirmed a diagnosis of disseminated cytomegalovirus (CMV) infection due to reactivation of latent disease.