Cytomegalovirus hepatitis: evidence for direct hepatic viral infection using monoclonal antibodies

Cytomegalovirus-induced hepatitis presented as acute right upper quadrant pain with a cholestatic profile in a middle-aged woman. The presentation was confused by the presence of gallstones. Her course was complicated by pleuritis, atypical lymphocytosis, lymphadenopathy, and transient arthritis. Urine virus cultures grew cytomegalovirus and seroconversion of indirect immunofluorescent antibody to late cytomegalovirus antigen was demonstrated. Biopsies of the patient's liver failed to grow cytomegalovirus or to show viral inclusions. Electron micrographic studies were negative. Biopsy specimens were stained with monoclonal antibodies to cytomegalovirus by an indirect fluorescence technique. Clearly defined inclusions were specifically stained. Both nuclear and cytoplasmic inclusions were demonstrated using monoclonal antibodies CH16 and CH12, respectively. Insofar as we are aware, this is the first reported direct evidence for hepatic viral infection with this virus in a previously healthy adult.