Cholestasis, ascites and pancytopenia in an immunocompetent adult with severe cytomegalovirus hepatitis

World J Gastroenterol. 2015 Nov 21;21(43):12505-9. doi: 10.3748/wjg.v21.i43.12505.

Abstract

Human cytomegalovirus (CMV) is a herpesvirus, which establishes lifelong latency after primary infection and leads to severe disease in immunocompromised patients. However, CMV infection in immunocompetent patients is usually asymptomatic and severe organ damage is rarely reported. We report a case of severe CMV hepatitis in an immunocompetent patient presenting with cholestasis, portal hypertension-related ascites and pancytopenia. The patient was asymptomatic with normal liver function and negative CMV DNA after two weeks of antiviral therapy. This case is an example of a common infection with an uncommon presentation, and suggests that testing for CMV should be carried out, even in patients with normal immune status, presenting with severe liver damage or cholestasis.

Keywords: Ascites; Cholestasis; Cytomegalovirus hepatitis; Immunocompetent adult; Pancytopenia.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Antiviral Agents / therapeutic use
  • Ascites / diagnosis
  • Ascites / virology*
  • Cholestasis / diagnosis
  • Cholestasis / virology*
  • Cytomegalovirus / drug effects
  • Cytomegalovirus / genetics
  • Cytomegalovirus / pathogenicity*
  • Cytomegalovirus Infections / diagnosis
  • Cytomegalovirus Infections / virology*
  • DNA, Viral / genetics
  • Female
  • Hepatitis, Viral, Human / diagnosis
  • Hepatitis, Viral, Human / virology*
  • Humans
  • Hypertension, Portal / diagnosis
  • Hypertension, Portal / virology
  • Immunocompetence*
  • Multimodal Imaging / methods
  • Pancytopenia / diagnosis
  • Pancytopenia / virology*
  • Positron-Emission Tomography
  • Severity of Illness Index
  • Time Factors
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Viral Load

Substances

  • Antiviral Agents
  • DNA, Viral