Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 6, 2022; 10(34): 12605-12609
Published online Dec 6, 2022. doi: 10.12998/wjcc.v10.i34.12605
Acute cytomegalovirus hepatitis in an immunocompetent patient: A case report
Jack P Wang, Bou-Zenn Lin, Chih-Lin Lin, Kuan-Yang Chen, Tsung-Jung Lin
Jack P Wang, Bou-Zenn Lin, Chih-Lin Lin, Kuan-Yang Chen, Tsung-Jung Lin, Department of Gastroenterology, Taipei City Hospital, Taipei City 10629, Taiwan
Tsung-Jung Lin, University of Taipei, Taipei City 10066, Taiwan
Author contributions: Lin TJ designed the research study; Lin BZ, Lin CL, and Chen KY performed the research; Wang JP analyzed the data and wrote the manuscript; All authors have read and approve the final manuscript.
Informed consent statement: Informed consent was obtained from the patient.
Conflict-of-interest statement: All the authors declare no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tsung-Jung Lin, MD, Attending Doctor, Department of Gastroenterology, Taipei City Hospital, No. 10 Section 4, Ren’ai Road, Da’an District, Taipei 10629, Taiwan. dab70@tpech.gov.tw
Received: August 15, 2022
Peer-review started: August 15, 2022
First decision: October 12, 2022
Revised: October 20, 2022
Accepted: November 4, 2022
Article in press: November 4, 2022
Published online: December 6, 2022
Processing time: 108 Days and 23 Hours
Abstract
BACKGROUND

Cytomegalovirus (CMV) infection is usually subclinical and asymptomatic in the healthy population, whereas severe complications occur in immunocompromised patients.

CASE SUMMARY

In this case report, we described a rare case of acute CMV hepatitis in a 35-year-old male immunocompetent patient who presented with a history of week-long intermittent fever with nonspecific constitutional symptoms. Acute hepatitis was suspected according to the initial serological tests. After ruling out other etiologies, including viral hepatitis A, B, C, drug, alcohol, autoimmune, and Wilson disease, acute CMV hepatitis was diagnosed based on positive CMV IgM and DNA quantitative tests. Because there was no any local acute hepatitis E reported in Taiwan, so hepatitis E was not checked. The patient recovered both clinically and serologically with symptomatic management and without antiviral therapy within 12 days from the onset of symptom.

CONCLUSION

In conclusion, a diagnosis of CMV infection should be considered when nonspecific prodromal symptoms occur in acute hepatitis with an uncertain etiology. Antiviral therapy should not be used in immunocompetent patient who had no decompensation of the liver, such as this patient. Widely available noninvasive tests for CMV can facilitate early diagnosis if used appropriately. Harm–benefit analysis is essential before using antiviral therapy in immunocompetent patients.

Keywords: Cytomegalovirus; Acute hepatitis; Immunocompetent; Case report

Core Tip: Cytomegalovirus (CMV) infection is usually subclinical and asymptomatic in the healthy population, whereas severe complications occur in immunocompromised patients. In this case report, we described a rare case of acute CMV hepatitis in a 35-year-old male immunocompetent patient who presented with a history of week-long intermittent fever with nonspecific constitutional symptoms. Acute hepatitis was suspected according to the initial serological tests. After ruling out other etiologies, acute CMV hepatitis was diagnosed based on positive CMV IgM and DNA quantitative tests. The patient recovered both clinically and serologically with symptomatic management and without antiviral therapy within 12 d from the onset of symptom.