Fever -> rule out left ventricular failure
TMP-SMX prophylaxis -> rule out Pneumocystis jiroveci
Kidney transplant but no WBC/RBC in urine -> rule out transplant rejection
Leaving CMV and atypical mycobacterium as the remaining two options. CMV is more likely in a transplant patient.
CMV is associated with infecting organ transplant patients. CMV is transmitted via sexual contact, organ transplant, or vertically via placenta. Reactivation of CMV occurs in the immunosuppressed.
Organ transplant patients are at an increased risk of CMV pneumonia.