Skip to main content
Journal of Clinical and Experimental Hepatology logoLink to Journal of Clinical and Experimental Hepatology
. 2012 Jan 2;1(3):207–209. doi: 10.1016/S0973-6883(11)60236-3

Atypical Presentation of Cytomegalovirus Infection in a Liver Transplant Patient

Naresh Bansal *, Anil Arora *,*, Vinay Kumaran **, Naimish Mehta **, Vibha Varma **, Praveen Sharma *, Pankaj Tyagi *, Munish Sachdeva *, Ashish Kumar *
PMCID: PMC3940243  PMID: 25755388

Abstract

Cytomegalovirus (CMV) is the most common viral infection in solid organ transplant recipients. Symptomatic infection usually presents with fever, pneumonia, colitis, or cytopenia. We describe a case of symptomatic CMV infection in a liver transplant recipient presenting with atypical symptoms of only persistent nausea and vomiting, in the absence of classical symptoms and signs; thus, highlighting the importance of high index of suspicion of CMV in immunocompromised patients, keeping in mind the high morbidity and mortality associated with this disease.

Keywords: Atypical presentation, cytomegalovirus, immunosuppressed, liver transplant, transplantation

Abbreviations: ALT, alanine aminotransferase; ANA, anti-nuclear antibody; anti-HBc, antibody-hepatitis B core; anti-HCV, antibody-hepatitis C virus; anti-LKM, antibody-liver–kidney-microsomal antigen; ASMA, antibody smooth muscle antigen; AST, aspartate aminotransferase; CMV, cytomegalovirus; EBV, Epstein-Barr virus; HBsAg, hepatitis B surface antigen; HEV, hepatitis E virus; INR, international normalized ratio; i.v., intravenous

Full Text

The Full Text of this article is available as a PDF (90.6 KB).

References

  • 1.Stratta RJ, Shaefer MS, Markin RS. Clinical patterns of cytomegalovirus disease after liver transplantation. Arch Surg. 1989;124:1443–1450. doi: 10.1001/archsurg.1989.01410120093018. [DOI] [PubMed] [Google Scholar]
  • 2.Linares L, Sanclemente G, Cervera C. Influence of cytomegalovirus disease in outcome of solid organ transplant patients. Transplant Proc. 2011;43:2145–2148. doi: 10.1016/j.transproceed.2011.05.007. [DOI] [PubMed] [Google Scholar]
  • 3.Kanj SS, Sharara AI, Clavien PA. Cytomegalovirus infection following liver transplantation: review of the literature. Clin Infect Dis. 1996;22:537–549. doi: 10.1093/clinids/22.3.537. [DOI] [PubMed] [Google Scholar]
  • 4.Milan A, Sampaio AM, Guardia AC. Monitoring and detection of cytomegalovirus in liver transplant recipients. Transplant Proc. 2011;43:1360–1361. doi: 10.1016/j.transproceed.2011.02.031. [DOI] [PubMed] [Google Scholar]
  • 5.Snydman DR. Infection in solid organ transplantation. Transpl Infect Dis. 1999;1:21–28. doi: 10.1034/j.1399-3062.1999.10103.x. [DOI] [PubMed] [Google Scholar]
  • 6.Hebart H, Kanj L, Jahn G, Einsele H. Management of cytomegalovirus infection after solid-organ or stem-cell transplantation: current guidelines and future prospects. Drugs. 1998;55:59–72. doi: 10.2165/00003495-199855010-00005. [DOI] [PubMed] [Google Scholar]
  • 7.Chaudhary A, Humar A. Postoperative complications after liver transplant. In: ECAB: Clinical Update Surgical Gastroenterology and Liver Transplantation: Liver Transplantation Nundy S, Soin A, eds. 2011:107-31.
  • 8.Hibberd PL, Tolkoff-Rubin NE, Cosimi AB. Symptomatic cytomegalovirus disease in the cytomegalovirus antibody seropositive renal transplant recipient treated with OKT3. Transplantation. 1992;53:68–72. doi: 10.1097/00007890-199201000-00013. [DOI] [PubMed] [Google Scholar]
  • 9.Falagas ME, Snydman DR. Recurrent cytomegalovirus disease in solid-organ transplant recipients. Transplant Proc. 1995;27(5 Suppl 1):34–37. [PubMed] [Google Scholar]
  • 10.Snydman DR. Cytomegalovirus prophylaxis strategies in high-risk transplantation. Transplant Proc. 1994;26(5 Suppl 1):20–22. [PubMed] [Google Scholar]
  • 11.Paya CV, Wiesner, Hermans PE. Risk factor for cytomegalovirus and severe bacterial infections following liver transplantation: a prospective multivariate time-dependent analysis. J Hepatol. 1993;18:185–195. doi: 10.1016/s0168-8278(05)80245-4. [DOI] [PubMed] [Google Scholar]
  • 12.Kusne S, Mulligan D. Transpl Infect. 2010:162–186. In: Risk and Epidemiology of Infections After Liver Transplantation. Bowden RA, Ljungman P, Syndman D, eds. [Google Scholar]
  • 13.Michelle Slifkin, Paola Tempesti, Debra D. Late and atypical cytomegalovirus disease in solid-organ transplant recipients. Clin Infect Dis. 2001;33:e62–e68. doi: 10.1086/322663. [DOI] [PubMed] [Google Scholar]
  • 14.The TH, van den Berq AP, van Bon WJ. Monitoring for cytomegalovirus after organ transplantation: a clinical perspective. Transplant Proc. 1993;25(5 Suppl 4):5–9. [PubMed] [Google Scholar]
  • 15.Alhyraba M, Grim SA, Benedetti E. Unusual presentation of cytomegalovirus enteritis after liver and kidney transplantation. Transpl Infect Dis. 2007;9:343–346. doi: 10.1111/j.1399-3062.2007.00276.x. [DOI] [PubMed] [Google Scholar]
  • 16.Agaimy A, Mudter J, Märkl B. Cytomegalovirus infection presenting as isolated inflammatory polyps of the gastrointestinal tract. Pathology. 2011;43:440–446. doi: 10.1097/PAT.0b013e3283485e51. [DOI] [PubMed] [Google Scholar]
  • 17.Khosravi M, Nobakht A, Nikokar AR. Cytomegalovirus disease with atypical presentation in a renal transplant patient: case report. Exp Clin Transplant. 2006;4:458–461. [PubMed] [Google Scholar]
  • 18.Ladd AM, Goyal R, Rosainz L. Pulmonary embolism and portal vein thrombosis in an immunocompetent adolescent with acute cytomegalovirus hepatitis. J Thromb Thrombolysis. 2009;28:496–499. doi: 10.1007/s11239-008-0303-1. [DOI] [PubMed] [Google Scholar]
  • 19.Valla F, Lévêque N, Escuret V. Human cytomegalovirus (HCMV) laryngitis: atypical HCMV disease presentation in haematopoietic stem cell transplantation. J Med Microbiol. 2008;57(Pt 11):1434–1435. doi: 10.1099/jmm.0.2008/001313-0. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Clinical and Experimental Hepatology are provided here courtesy of Elsevier

RESOURCES