with tenderness and positive Homan's sign. Deep venous thrombosis (DVT) of left lower extremity with pulmonary embolism (PE) was suspected and lower extremity venous doppler revealed acute extensive DVT in the left femoral, popliteal, gastrocnemius and calf veins. A contrast computed tomography chest scan using PE protocol was suggestive of bilateral pulmonary emboli. Anticoagulation with heparin and coumadin was started simultaneously. The fevers were initially thought to be secondary to thromboembolism but did not abate although patient was on heparin infusion and further evaluation showed atypical lymphocytosis and viral serology for Epstein-Barr virus, Cytomegalovirus and Herpes virus was performed. This revealed evidence of acute Cytomegalovirus (CMV) infection with elevated immunoglobulin M (IGM) of >5.0 and positive polymerase chain reaction (PCR) copies at 5,279 copies/mL. Treatment with ganciclovir for one week resolved his fevers and CMV PCR later became undetectable. Lower extremity pain and swelling improved and the patient was discharged on coumadin.He was followed as an outpatient but he did not experience total resolution of lower extremity symptoms. Venous doppler of left lower extremity showed persistent venous thrombi and he received two sessions of intravascular catheter directed thrombolysis with tissue plasminogen activator, mechanical thrombectomy followed by low molecular heparin therapy (with enoxaparin) and coumadin was discontinued. (Figure 1) shows the venogram of left lower extremity before catheter directed thrombolysis and (Figure 2) shows venogram after catheter directed thrombolysis with improved venous patency.On enoxaparin therapy, he experienced complete resolution of symptoms and was able to restart coumadin. Thrombophilia work up before initiation of anticoagulants showed presence of for lupus anticoagulant, but the repeat testing did not show this. Currently patient is maintained on aspirin and lower extremity compression stockings with no further recurrences of DVT.