ESRA TANYEL, Meltem KARSLIOĞLU ÇELİK, ŞABAN ESEN

İmmunkompetan Bir Cerrahta Gelişen Akut Cytomegalovirus Hepatiti

İmmunkompetan kişilerde Cytomegalovirus (CMV) infeksiyonu asemptomatik veya mononükleoz benzeri bir tablo ile seyreder, şiddetli hastalık gelişmesi nadirdir. CMV kan, vücut sıvıları, cinsel, plasental yolla ve transplante edilen organlar aracılığı ile bulaşır. Burada önceden sağlıklı olan genç bir erkekte gelişen ve polimeraz zincir reaksiyonu (PZR) CMV DNA ile tanısı konulan akut CMV hepatiti olgusu sunulmuştur. Yirmi sekiz yaşında erkek cerrah kliniğimize üç haftadır devam eden ateş yakınması ile başvurdu. Kabulünde vücut sıcaklığı 380C ve fizik muayenesi hepatomegali dışında normaldi. Laboratuvarında beyaz küre sayısı hafifçe artmış (10000/mm3)ve periferik kan yaymasında atipik lenfositler (>10%) mevcuttu. Karaciğer fonksiyon testleri artmıştı ve geniş serolojik taramada herhangi bir viral hepatit etkeni izole edilemedi. CMV IgM pozitif ve IgG negatif olarak saptandı. Kanda PZR CMV DNA (1150 kopya/mL; normal aralık

Acute Cytomegalovirus Hepatitis In An Immunocompetent Surgeon

Cytomegalovirus (CMV) infection in the immunecompetent individual is asymptomatic or manifested as a mononucleosis-like syndrome, and severe organ damage is rarely reported. CMV is transmitted through blood, body fluids, sexual and placental transfer, and transplanted organs. Here, we describe a previously healthy male patient of acute CMV hepatitis in whom the diagnosis was established by polymerase chain reaction (PCR) CMV-DNA. A 28-year-old males urgeon was admitted tour out patient clinic with complaints of fever for three weeks. Upon admission the patient presented body temperature was 380C and physical examination revealed normal finding sotherthanhepatomegaly. Laboratory data revealed a slightly increased white blood cell (10000/mm3) with a typically mphocytes (>10%) in peripheral blood smear. His liver enzyme concentrations were elevated and an extensive serological screening to identify any viral cause of hepatitis. The CMV IgM was positive, and IgG was negative. PCR of his blood was elevated for CMV DNA (1150 copies/mL; normal range<150copies/mL). Treatment with ganciclovir was initiated, after which his liver function began to improve and her general condition recovered. In the literature, several immune competent cases with CMV hepatitis have been reported. In addition, patients may develop cholestatic hepatitis, granulomatous hepatitis, or fulminant hepatic failure requiring liver transplantation due to CMV infection. Viral culture, serology, CMV antigenemia, histopathological examination, and PCR can be used in the diagnosis of CMV infections. Anti-CMV immunoglobulins have low specificity and sensitivity during acute infection. The gold standard in the diagnosis is CMV-DNA level measured in the blood using PCR, and quantitative measurement is particularly important for follow-up. The present case report is note worthy for reminding CMV as an etiological factor for clinical presentation with fever, hepatomegaly, and elevated liver enzymes, when other factor sare excluded.

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