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Liver and intrahepatic bile ducts-nontumor

Viral hepatitis

Cytomegalovirus hepatitis (CMV)


Reviewers: Komal Arora, M.D. (see Reviewers page)
Revised: 12 May 2012, last major update May 2012
Copyright: (c) 2004-2012, PathologyOutlines.com, Inc.

General
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● Affects immunocompetent and immunocompromised
● Liver may be involved in congenital CMV infection
● Usually acute self-limited disease resembling infectious mononucleosis
● May be associated with massive hepatic necrosis
● Associated with viral-associated hemophagocytic syndrome, with prominent erythrophagocytosis by sinusoidal Kupffer cells and portal histiocytes (DD: sinus histiocytosis with massive lymphadenopathy - nodular, portal areas uninvolved)

Micro description
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● Predominantly sinusoidal infiltrate of atypical lymphocytes with minimal necrosis
● Variable mitotic figures and small epithelioid granulomas
● Ring granulomas of the type usually associated with Q fever occur
● Immunocompromised patients have enlarged endothelial cells, bile duct epithelium or hepatocytes with large, eosinophilic to amphophilic nuclear inclusions surrounded by a clear halo, and cytoplasmic inclusions consisting of basophilic dots (inclusions are viral particles); microabscesses composed of neutrophils are present instead of lymphocytes
● CMV stains not helpful for diagnosis

Micro images
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Intranuclear and cytoplasmic inclusions in neonatal hepatitis

Differential diagnosis
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● EBV, hepatitis C, diphenylhydantoin drug reaction

Additional references
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Liver 1997;17:129

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


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