[Portal vein thrombosis associated with an acute cytomegalovirus infection].
Portal vein thrombosis is an unusual condition and its association with an acute cytomegalovirus (CMV) infection is known but rarely reported. We present here the case of a 24-year-old woman suffering from a symptomatic portal vein thrombosis, confirmed by CT angiography, and acute CMV-related hepatitis. Besides a second generation oral contraceptive with estrogen and progesterone, not associated with smoking, the acute CMV infection was the only cause found to have provoked the venous thrombosis; a myeloproliferative disorder or biological thrombophilia were ruled out. The patient rapidly recovered with vitamin K antagonists (VKA) anticoagulant treatment. Eighteen cases of splanchnic vein thrombosis complicating acute CMV infection were found in the literature. All patients had acute hepatitis. The outcome was usually favorable with warfarin therapy for a period lasting 3 to 7 months. Antiviral treatment (anti-CMV) was used in three cases of severe infection. The antiviral therapy was given only in immunosuppressed patients. For immunocompetent patients, CMV infection is usually asymptomatic and clinical signs are often non-specific and mild, not requiring treatment.


CONCLUSIONS
This case report and the review of the literature recall the need to search for acute CMV infection in patients with portal thrombosis so a possible transient trigger for venous thromboembolism can be identified, avoiding extended anticoagulation.
Médecine vasculaire, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France. Electronic address: agalloula@gmail.com.
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Galloula
Médecine vasculaire, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, 75006 Paris, France.
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Rossi
Médecine vasculaire, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France.
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Gautier
Équipe mobile d'infectiologie, hôpital européen Georges-Pompidou, 75015 Paris, France.
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Minozzi
Médecine vasculaire, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, 75006 Paris, France; Inserm U970, PARCC, 75015 Paris, France.
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Messas
Médecine vasculaire, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, 75006 Paris, France; Inserm U970, PARCC, 75015 Paris, France.
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Mirault
D000208:Acute Disease; D000925:Anticoagulants / Q000627:therapeutic use; D003277:Contraceptives, Oral, Combined / Q000009:adverse effects; D003278:Contraceptives, Oral, Hormonal / Q000009:adverse effects; D003586:Cytomegalovirus Infections / Q000097:blood / Q000150:complications*; D004997:Ethinyl Estradiol / Q000009:adverse effects; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006525:Hepatitis, Viral, Human / Q000097:blood / Q000150:complications*; D006801:Humans; D016912:Levonorgestrel / Q000009:adverse effects; D011169:Portal Vein; D020246:Venous Thrombosis / Q000188:drug therapy / Q000209:etiology*; D014859:Warfarin / Q000627:therapeutic use; D055815:Young Adult
D000925:Anticoagulants; D003277:Contraceptives, Oral, Combined; D003278:Contraceptives, Oral, Hormonal; D006495:Heparin, Low-Molecular-Weight; D004997:Ethinyl Estradiol; D014859:Warfarin; D016912:Levonorgestrel
Cytomegalovirus infection; Infection à cytomégalovirus; Maladie thromboembolique veineuse; Portal vein; Veine porte; Venous thromboembolism