Liver & intrahepatic bile ducts
Viral hepatitis
Cytomegalovirus hepatitis
Author: Rifat Mannan, M.B.B.S., M.D.
Last author update: 1 May 2016
Last staff update: 16 February 2023 (update in progress)
Copyright: 2002-2023, PathologyOutlines.com, Inc.
PubMed Search: Cytomegalovirus hepatitis
Table of Contents
Definition / general | Essential features | Epidemiology | Etiology | Clinical features | Microscopic (histologic) description | Microscopic (histologic) images | Positive stains | Differential diagnosis | Additional referencesCite this page: Mannan A.A.S.R. Cytomegalovirus hepatitis. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/liverCMV.html. Accessed June 2nd, 2023.
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
Microscopic (histologic) 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
- 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
Microscopic (histologic) images
Images hosted on other servers:
Classical CMV cytopathic effect
Neutrophilic microabscess in acute CMV hepatitis
Microgranuloma associated with CMV hepatitis
CMV immuno-histochemistry
Positive stains
Differential diagnosis
- EBV associated hepatitis:
- Positive heterophil antibodies
- Herpes simplex virus hepatitis:
- IHC for HSV1 / 2 and serology is helpful
- Transplant rejection:
- No viral cytopathic effect; negative CMV IHC
Additional references
