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Abstract
Cytomegalovirus (CMV) is a clinically important pathogen in immunocompromised patients, especially after organ transplantation. However, there have been several reports of severe CMV infections in immunocompetent patients. This report presents a case of an immunocompetent patient who presented with fulminant hepatitis requiring liver transplantation. Because CMV was detected upon histopathologic review of the explanted liver, it was later assumed that CMV may be the primary cause of hepatitis. However, at the time of transplantation, we did not suspect CMV hepatitis. Following transplantation and initiation of immunosuppress on, the patient developed viral sepsis with a disseminated CMV infection. Respiratory failure because of CMV pneumonia worsened despite antiviral therapy, and venovenous extracorporeal membrane oxygenation (ECMO) was initiated. Although ECMO has been traditionally contraindicated in patients with sepsis, this patient recovered and was successfully weaned off ECMO. CMV should be included in the differential diagnosis of fulminant hepatitis, even in immunocompetent patients, especially when liver transplantation is considered.
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Fig. 1.
Bilateral lung opacities developed after liver transplantation. (A) As shown in the chest computed tomography image, bilateral consolidation was initially seen predominantly in both the upper lobes (postoperative day [POD] 5). (B) However, it progressed to involve the entire lung field (POD 7). (C) A simple chest radiograph taken after the initiation of extracorporeal membrane oxygenation (ECMO) showing that most of the lung was non-aerated (POD 10). (D) A chest radiograph taken 3 months after weaning off ECMO shows dramatic improvement (POD 120).
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