Marshall University Joan C. Edwards School of Medicine Huntington, WV
Bassel Dakkak, MD, Yasmeen Obeidat, MD, Leen Kayali, MD, Tejas Joshi, MD, Ahmed Sherif, MD Marshall University Joan C. Edwards School of Medicine, Huntington, WV
Introduction: Cytomegalovirus (CMV) is a prevalent congenital infection. Many newborns with congenital CMV are asymptomatic, but symptoms can include microcephaly, hepatosplenomegaly, rash, hearing loss, and chorioretinitis. Liver involvement usually presents as hepatitis or cholestatic disease, which are generally reversible. However, chronic liver disease and portal hypertension due to CMV are rare. This report presents a male patient initially diagnosed with cirrhosis attributed to congenital CMV. A recent liver biopsy revealed non-cirrhotic portal hypertension, indicating that CMV can induce liver fibrosis without cirrhosis but still result in portal hypertension. This case contributes to the limited literature on CMV-induced liver injury.
Case Description/Methods: A 30-year-old male, previously diagnosed with congenital CMV and hearing loss, presented with concerns about liver cirrhosis attributed to his congenital CMV and abnormal liver enzymes (Table 1). At age 14, he underwent a splenectomy for thrombocytopenia and experienced hematemesis from esophageal varices due to portal hypertension, requiring serial band ligation procedures. An extensive workup for celiac disease, alpha-1 antitrypsin deficiency, autoimmune markers, IgG subclasses, hepatitis serology, HIV, and iron panel all returned negative, and his physical exam was unremarkable. A CT-guided liver biopsy revealed a dilated portal vein, periductal fibrosis, nodular liver parenchyma with ballooned cells, inflammatory infiltrates with lymphocytes, focal interface hepatitis, and mild zone 3 sinusoidal dilatation without steatosis (Figure1). Special stains showed a mild ductular reaction and native bile ducts with intermediate hepatocytes and focal portal fibrosis (Figure 2). The findings suggested non-cirrhotic portal hypertension, likely due to congenital CMV. The patient is currently managed with carvedilol.
Discussion: Congenital CMV can rarely lead to chronic liver diseases. This case highlights an adult patient with congenital CMV causing non-cirrhotic portal hypertension, misdiagnosed as cirrhosis for years. His liver biopsy, performed in adulthood, revealed fibrotic changes without cirrhosis. His condition remained manageable with carvedilol, aligning with biopsy findings of minor liver injury. Given the varied severity of CMV-induced liver injury, which can be fatal, research on whether early diagnosis and management affect the outcome of CMV-induced chronic liver injury is needed. ChatGPT improved grammar; content by authors.
Figure: Figure 1: Portal tracts and bile ducts stained with Hematoxylin and Eosin (H&E) show dilated portal veins, focally herniating into the surrounding parenchyma. Scale bar = 50 μm, 100X magnification Figure 2: Trichrome stain highlighting focal portal fibrosis, associated with occasional slender septal fibrosis. Scale bar = 50 μm, 100X
Note: The table for this abstract can be viewed in the ePoster Gallery section of the ACG 2024 ePoster Site or in The American Journal of Gastroenterology's abstract supplement issue, both of which will be available starting October 27, 2024.
Disclosures:
Bassel Dakkak indicated no relevant financial relationships.
Yasmeen Obeidat indicated no relevant financial relationships.
Leen Kayali indicated no relevant financial relationships.
Ahmed Sherif indicated no relevant financial relationships.
Bassel Dakkak, MD, Yasmeen Obeidat, MD, Leen Kayali, MD, Tejas Joshi, MD, Ahmed Sherif, MD. P4742 - Congenital Cytomegalovirus Infection: A Rare Cause of Non-Cirrhotic Portal Hypertension, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
