[Granulomatous hepatitis in cytomegalovirus infection in healthy adults]

The authors report 16 cases of cytomegalovirus (CMV) disease in previously healthy adults. Constant features included pyrexia lasting 3 to 8 weeks and mononucleosis occurring 2-3 weeks after the onset of fever. Moderate hepatomegaly without jaundice, splenomegaly and morbilliform or petechial rush were observed in 30 to 50 p. 100 of cases. None had pharyngitis. Mild increase in serum transaminase activity (2 to 5 N) was present in 13 of the 16 patients, but increased alkaline phosphatase activity was observed in only 3 of them. Liver biopsy was obtained in 10 patients. Liver lesions were characterised by the association of intra lobular granuloma, abundant mononuclear cells in the sinusoids and hepatic peri-venous inflammation but hepatocellular necrosis was not prominent. Typical intracellular inclusions were not seen, either in hepatocytes or in cells of biliary ducts. The diagnosis was ascertained by positive viremia and or viruria and presence of IgM antibodies. The outcome was favourable although clinical and biological signs lasted for about 8 weeks. The authors conclude that adults with chronic pyrexia, no pharyngitis and sub-clinical hepatitis with mild increases in transaminase activity and histologic mononucleosis hepatitis showing mononuclear infiltrates and granuloma formation are likely to have CMV disease.