Chan Aaron, Bazerbachi Fateh, Hanson Brian, Alraies M Chadi, Duran-Nelson Alisa
Department of Medicine, University of Minnesota, Minneapolis, MN.
Ochsner J. 2014 Summer;14(2):295-9.
Cytomegalovirus (CMV) is a double-stranded DNA virus and a member of the Herpesviridae family. It is a lytic virus that causes a cytopathic effect in vitro and in vivo. CMV affects nearly all humans, with a 60%-100% seroprevalence worldwide, and in the immunocompetent it typically manifests as a mild and self-limiting mononucleosis syndrome. In immunocompromised patients, CMV has the ability to cause significant inflammation in many different organ systems.
We report an unusual case of hepatitis and pancreatitis secondary to CMV in an immunocompetent patient. A 29-year-old male was admitted with elevated lipase, elevated aminotransferases, and epigastric pain after an acute viral prodrome. An initial CMV DNA polymerase chain reaction workup was positive, indicating acute or reactivated infection. Liver histology was consistent with CMV infection. Magnetic resonance cholangiopancreatography, endoscopic ultrasound, and intraoperative cholangiogram were not indicative of other etiologies. CMV viremia was successfully cleared with ganciclovir, and the patient experienced clinical and biochemical improvements.
Pancreatitis and hepatitis secondary to CMV are rare but should be considered in the workup of immunocompetent patients, especially in the presence of a recent viral-like illness.
巨细胞病毒（CMV）是一种双链DNA病毒，属于疱疹病毒科。它是一种溶细胞病毒，在体外和体内均可引起细胞病变效应。CMV几乎感染所有人类，全球血清阳性率为60%-100%，在免疫功能正常者中通常表现为轻度自限性单核细胞增多症综合征。在免疫功能低下的患者中，CMV能够在许多不同器官系统中引起显著炎症。
我们报告一例免疫功能正常患者继发于CMV的肝炎和胰腺炎不寻常病例。一名29岁男性在急性病毒前驱症状后因脂肪酶升高、转氨酶升高和上腹部疼痛入院。最初的CMV DNA聚合酶链反应检查呈阳性，表明为急性或再激活感染。肝脏组织学与CMV感染一致。磁共振胰胆管造影、内镜超声和术中胆管造影均未提示其他病因。更昔洛韦成功清除了CMV病毒血症，患者临床和生化指标均有改善。
CMV继发的胰腺炎和肝炎虽罕见，但在免疫功能正常患者的检查中应予以考虑，尤其是近期有类似病毒感染症状时。
