Acute CMV hepatitis in an immunocompetent patient

Area of Science:

• Hepatology
• Virology
• Immunology

Background:

• Cytomegalovirus (CMV) is a common virus that can remain latent in the body.
• Reactivation typically occurs in immunocompromised individuals.
• Acute hepatitis is inflammation of the liver, often caused by viral infections.

Observation:

• A previously healthy, immunocompetent 64-year-old woman presented with fever of unknown origin and acute hepatitis.
• Initial investigations suggested a viral or autoimmune cause, but imaging provided no clarity.
• The patient experienced headache and nausea but no other significant symptoms.

Findings:

• Serology and nucleic acid amplification tests confirmed reactivation of latent cytomegalovirus (CMV).
• The patient's acute hepatitis and fever resolved with supportive care alone.
• No antiviral therapy was required for this CMV reactivation.

Implications:

• CMV reactivation should be considered in the differential diagnosis of acute hepatitis, even in immunocompetent patients.
• This case underscores the importance of considering less common etiologies for hepatitis.
• Early identification of CMV reactivation can guide appropriate management, potentially avoiding unnecessary treatments.