Liver and intrahepatic bile ducts-nontumor
Viral hepatitis
Cytomegalovirus hepatitis (CMV)

Author: Rifat Mannan, M.D. (see Authors page)

Revised: 6 May 2016, last major update May 2016

Copyright: (c) 2003-2016, PathologyOutlines.com, Inc.

PubMed Search: cmv hepatitis
Cite this page: Cytomegalovirus hepatitis (CMV). PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/liverCMV.html. Accessed December 6th, 2016.
Definition / General
  • Most clinically significant infections are associated with immunosuppression, such as HIV/AIDS, organ transplantation or congenital infection
Essential Features
  • Cytomegaly with intranuclear and intracytoplasmic inclusions are characteristic
Epidemiology
  • At least 50% of adults in USA have serologic evidence of past infection, but this is usually asymptomatic
Etiology
  • CMV is a member of the Herpesviridae family of viruses
  • Infection can be acquired before birth, at birth or later in life
  • After active infection, latent infection usually persists for years
  • Reactivation may be due to impaired host immunity
Clinical Features
  • Most infections are clinically silent
  • In immunocompromised hosts, mononucleosis-like illness is a common presentation, with highly variable symptoms, which may include malaise, fever, myalgias, nausea and abdominal pain
  • Congenital infection is characterized by asymptomatic to severe infection with jaundice, hepatosplenomegaly, encephalitis and chorioamnionitis
Micro Description
  • CMV hepatitis is characterized by the classic CMV viral cytopathic effect in hepatocytes, biliary epithelium, endothelial cells and Kupffer cells:
    • Infected cells have both cytoplasmic and nuclear enlargement
    • Cytoplasmic and nuclear inclusions are characteristic
    • Cytoplasmic inclusions are basophilic / amphophilic granules that stain positive for PAS and GMS stains
    • Nuclear inclusions (Cowdry type A inclusion) have ‘owl-eye’ morphology: large glassy round to oval masses within nucleus separated by clear halo from the thickened nuclear membrane
    • A mononucleosis-like pattern is characterized by a prominent mononuclear infiltrate within portal tracts and sinusoids; granulomas may also be present, but viral inclusions are usually absent and immunohistochemistry may not be helpful
  • In immunosuppressed hosts, CMV cytopathic effect is typically observed
    • Other nonspecific changes include mild lobular hepatitis, hepatocellular necrosis and patchy portal mononuclear infiltrate
    • Microabscesses can be seen as well
Micro Images

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Classical CMV cytopathic effect


Neutrophilic microabscess in acute CMV hepatitis


Microgranuloma associated with CMV hepatitis

CMV immunohistochemistry


Positive Stains
Differential Diagnosis