Abstract
Aim Cytomegalovirus (CMV) can cause hepatitis, encephalomyelitis, and pneumonitis in immunocompromised patients. In contrast, CMV infection of immunocompetent patients can lead to the development of infectious mononucleosis and is typically self-limiting; severe complications are rare. We evaluated the pathophysiology and immunological aspects of CMV hepatitis in recently immunocompetent adult patients. Methods We examined the clinical features and outcomes of 47 adult immunocompetent patients with CMV hepatitis (29 men, 18 women; mean age, 34 ± 11 years) from January 2005 to August 2019 treated in our hospital. We also assayed T-cell activation to evaluate the immune responses in these patients. Results Fever (74.5%), hepatosplenomegaly (74.5%), sore throat (36.2%), headache (31.9%), abdominal pain (27.7%), lymphadenopathy (23.4%), and skin rash (6.4%) were present at admission. Complications included gastrointestinal injury (25.5%), neuropathy (4.3%), thrombocytopenia (2.1%), and splenic infarction (2.1%). All patients had a good clinical course without liver failure or transition to chronic liver injury. The time to recover from liver injury ranged from 12 to 142 days (mean, 43.4 ± 28.7 days). The serum sIL-2R level, which reflects T-cell activation, was transiently elevated and correlated with the extent of hepatic inflammation. Conclusions CMV hepatitis in immunocompetent individuals has a satisfactory outcome, but occasionally results in complications in other organs. The sIL-2R level has potential as a surrogate marker of hepatic inflammation in immunocompetent patients with CMV hepatitis.
Highlights
Reactivation of latent cytomegalovirus (CMV) infection or acquisition of primary CMV infection can result in encephalitis, pneumonitis, hepatitis, uveitis, retinitis, colitis, and graft rejection in immunocompromised patients [1]
We examined the clinical features and outcomes of CMV-infected immunocompetent patients and assessed the immunological response to CMV infection by assaying the soluble interleukin-2 receptor (sIL-2R) level and CD4/CD8 T-cells ratio
The serum sIL-2R level was assessed in 24 patients with CMV infection (17 men, 7 women; mean age, 61 ± 7 years) (Table 2)
Summary
Reactivation of latent cytomegalovirus (CMV) infection or acquisition of primary CMV infection can result in encephalitis, pneumonitis, hepatitis, uveitis, retinitis, colitis, and graft rejection in immunocompromised patients [1]. In immunocompetent patients, primary CMV infection typically manifests as an undifferentiated viral syndrome or an infectious mononucleosis-like syndrome. CMV infection in such individuals is considered to be of minimal importance [2]. The rate of primary CMV infection has increased recently. The disease is considered to be benign and self-limiting in immunocompetent individuals; some recent reports have indicated that CMV infection of immunocompetent patients can result in severe clinical manifestations [4]. Further research is needed regarding CMV infection in recently immunocompetent individuals. The immune response in immunocompetent patients with CMV hepatitis is unclear. We examined the clinical features and outcomes of CMV-infected immunocompetent patients and assessed the immunological response to CMV infection by assaying the sIL-2R level and CD4/CD8 T-cells ratio
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