A rare case of cytomegalovirus hepatitis mimicking malignancy in an immunocompetent adult

Abstract

Cytomegalovirus (CMV) is a highly prevalent pathogen that remains dormant in majority of the cases. Severe CMV infection is generally limited to immunocompromised hosts. While occasional cases of CMV hepatitis are observed in healthy immunocompetent hosts, it is very rare to find this associated with focal liver lesions mimicking malignancy. Cases of non-immunosuppressed CMV reactivation, CMV-associated liver lesions, and CMV-associated portal vein thrombosis have all been reported individually, we present a single case of CMV with all of these rare manifestations.

Keywords: Cytomegalovirus; Hepatitis; Immunocompetent; Liver lesion(s), Malignancy.

Fig. 1

(A) Axial CT abdomen image after administration of intravenous iodinated contrast in portal venous phase showing a large ill-defined mass-like region of heterogeneous low density in hepatic segments 5 and 6 measuring approximately 7.5 × 6.3 × 8.0 cm, extending to the hilar region (orange arrow). (B) Wedge-shaped heterogeneous density lesion involving segment 8 (blue arrow). (C) Thrombus within the right portal vein (green arrow).

Fig. 2

MRI liver with intravenous gadolinium contrast on axial T2 sequence showing moderately hyperintense 59.2 × 43.9 mm mass within hepatic segments 5 and 6 (A) and within segment 8 (B) along perivasculobiliary tracts (blue arrow).

Fig. 3

Follow-up MRI liver on axial T2 sequence showing near-resolution of segment 5 and 6 liver lesion (A) (yellow arrow) and segment 8 lesions (B) (blue arrow).

Fig. 4

Histopathology from liver biopsy. (A) H&E high power image, ×400 (Hematoxylin and eosin) demonstrating CMV inclusion bodies (green arrow), and infiltrate of inflammatory cells which include plasma cells (red arrow). (B) CMV IHC stain, ×200 (immunohistochemistry staining) demonstrating inclusion bodies which stain a distinctive brown (green arrows).