Published online Nov 21, 2015. doi: 10.3748/wjg.v21.i43.12505
Peer-review started: May 11, 2015
First decision: July 10, 2015
Revised: July 20, 2015
Accepted: September 14, 2015
Article in press: September 15, 2015
Published online: November 21, 2015
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.
Core tip: Human cytomegalovirus (CMV) can establish lifelong latency after primary infection. It also leads to severe disease in immunocompromised patients. However, CMV infection in immunocompetent patients is usually asymptomatic and severe organ damage is rarely reported. Here, we report an immunocompetent patient with a unique presentation of severe CMV hepatitis manifested by cholestasis, ascites and pancytopenia. The patient was asymptomatic with normal liver function and negative CMV DNA after two weeks of antiviral therapy. It is suggested that testing for CMV should be carried out, even in patients with normal immune status, presenting with severe liver damage or cholestasis.