 and the changes in her CAT scan, the patient was taken for a bronchoscopy.  BAL and transbronchial biopsies were performed.  The transbronchial biopsies did not show any evidence of pneumocystis, fungal infection, AFB.  There was some nonspecific interstitial fibrosis, which was minimal.  I spoke with the pathologist, Dr. XYZ and immunopathology was done to look for CMV.  The patient had 3 nucleoli on the biopsy specimens that stained positive and were consistent with CMV infection.  The patient was started on ganciclovir once her CMV serologies had come back positive.  No other antibiotic therapy was prescribed.  Next, the patient's methotrexate was held.