Siewert Elmar, Geier Andreas, Dietrich Christoph G, Backes Berthold, Matern Siegfried, Gartung Carsten
Medizinische Klinik III, Universitätsklinikum Aachen, Aachen.
Med Klin (Munich). 2004 Mar 15;99(3):154-61. doi: 10.1007/s00063-004-1024-7.
Infections by cytomegalovirus (CMV) cause substantial morbidity and mortality in immunocompromised patients, whereas immunocompetent individuals generally experience mild disease or remain asymptomatic.
A 54-year-old immunocompetent man undergoing CMV mononucleosis and hepatitis after primary infection is reported. Symptoms were pronounced with considerably reduced general condition and sustained highly febrile temperatures. Only therapy with intravenous ganciclovir led to rapid resolution of the disease. A second case describes a 31-year-old woman who, having had contact with a CMV-infected infant, developed a mononucleosis-like illness during her pregnancy. Due to the risk of congenital CMV infection, the exclusion of CMV-caused infection or the discrimination between primary and secondary infection is of particular importance, and the second case illustrates the relevant diagnostic difficulties and pitfalls.
As demonstrated by the two cases, even in immunocompetent patients and pregnant women CMV should be considered in the differential diagnosis of symptomatic viral infections. Particularly during pregnancy and after organ transplantation, early diagnosis and prognostic markers are necessary because of possible severe complications such as congenital CMV infection and organ transplant failure.
巨细胞病毒（CMV）感染在免疫功能低下的患者中会导致严重的发病和死亡，而免疫功能正常的个体通常经历轻度疾病或无症状。
报道了一名54岁免疫功能正常的男性，在初次感染后发生CMV单核细胞增多症和肝炎。症状明显，全身状况显著下降，持续高热。仅静脉注射更昔洛韦治疗导致疾病迅速缓解。第二例描述了一名31岁女性，在接触CMV感染的婴儿后，在怀孕期间患上了类似单核细胞增多症的疾病。由于存在先天性CMV感染的风险，排除CMV引起的感染或区分原发性和继发性感染尤为重要，第二例说明了相关的诊断困难和陷阱。
如这两个病例所示，即使在免疫功能正常的患者和孕妇中，在有症状的病毒感染鉴别诊断中也应考虑CMV。特别是在怀孕期间和器官移植后，由于可能出现严重并发症，如先天性CMV感染和器官移植失败，早期诊断和预后标志物是必要的。
