title: Cholestasis, ascites and pancytopenia in an immunocompetent adult with severe cytomegalovirus hepatitis.
abstract: Human cytomegalovirus (CMV) is a herpesvirus, which establishes lifelong latency after primary infection and leads to severe disease in immunocompromised patients. However, CMV infection in immunocompetent patients is usually asymptomatic and severe organ damage is rarely reported. We report a case of severe CMV hepatitis in an immunocompetent patient presenting with cholestasis, portal hypertension-related ascites and pancytopenia. The patient was asymptomatic with normal liver function and negative CMV DNA after two weeks of antiviral therapy. This case is an example of a common infection with an uncommon presentation, and suggests that testing for CMV should be carried out, even in patients with normal immune status, presenting with severe liver damage or cholestasis.
authors.affiliation: Jun-Yan Qian, Xiao-Yin Bai, Department of Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
authors.forename: Jun-Yan
authors.initials: JY
authors.lastname: Qian
authors.affiliation: Jun-Yan Qian, Xiao-Yin Bai, Department of Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
authors.forename: Xiao-Yin
authors.initials: XY
authors.lastname: Bai
authors.affiliation: Jun-Yan Qian, Xiao-Yin Bai, Department of Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
authors.forename: Yun-Lu
authors.initials: YL
authors.lastname: Feng
authors.affiliation: Jun-Yan Qian, Xiao-Yin Bai, Department of Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
authors.forename: Wen-Jia
authors.initials: WJ
authors.lastname: Zhu
authors.affiliation: Jun-Yan Qian, Xiao-Yin Bai, Department of Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
authors.forename: Fang
authors.initials: F
authors.lastname: Yao
authors.affiliation: Jun-Yan Qian, Xiao-Yin Bai, Department of Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
authors.forename: Jing-Nan
authors.initials: JN
authors.lastname: Li
authors.affiliation: Jun-Yan Qian, Xiao-Yin Bai, Department of Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
authors.forename: Ai-Ming
authors.initials: AM
authors.lastname: Yang
authors.affiliation: Jun-Yan Qian, Xiao-Yin Bai, Department of Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
authors.forename: Fang
authors.initials: F
authors.lastname: Li
authors.affiliation: Jun-Yan Qian, Xiao-Yin Bai, Department of Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
authors.forename: Jia-Ming
authors.initials: JM
authors.lastname: Qian
mesh_terms: D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use; D001201:Ascites / Q000175:diagnosis / Q000821:virology*; D002779:Cholestasis / Q000175:diagnosis / Q000821:virology*; D003587:Cytomegalovirus / Q000187:drug effects / Q000235:genetics / Q000472:pathogenicity*; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000821:virology*; D004279:DNA, Viral / Q000235:genetics; D005260:Female; D006525:Hepatitis, Viral, Human / Q000175:diagnosis / Q000821:virology*; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis / Q000821:virology; D007121:Immunocompetence; D064847:Multimodal Imaging / Q000379:methods; D010198:Pancytopenia / Q000175:diagnosis / Q000821:virology*; D049268:Positron-Emission Tomography; D012720:Severity of Illness Index; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral
keywords: Ascites; Cholestasis; Cytomegalovirus hepatitis; Immunocompetent adult; Pancytopenia