Liver Disease in Cytomegalovirus Mononucleosis: A Light Microscopical and Immunoperoxidase Study of Six Cases

Authors

  • Dale C. Snover,

    Corresponding author
    1. Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, Minnesota 55455 and Department of Laboratory Medicine, Mt. Sinai Hospital, Minneapolis, Minnesota 55404
    • Dale C. Snover, M.D., Laboratory Medicine and Pathology, Box 609 Mayo, University of Minnesota, 420 Delaware Street, S.E., Minneapolis, Minnesota 55455.
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    • Dr. Snover is a Junior Faculty Clinical Fellow of The American Cancer Society.

  • Charles A. Horwitz

    1. Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, Minnesota 55455 and Department of Laboratory Medicine, Mt. Sinai Hospital, Minneapolis, Minnesota 55404
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Abstract

Six liver biopsies from previously healthy adult patients with cytomegalovirus (CMV) mononucleosis were studied by routine light microscopy and by the immunoperoxidase technique for CMV antigen. Light microscopical findings consisting of a mononuclear portal and sinusoidal infiltrate, increased hepatocellular mitotic activity and minimal hepatocellular necrosis were consistently found. Less common features were granuloma formation and bile duct epithelial damage. Typical CMV nuclear inclusions and CMV antigen were identified in only one case, a patient with marked leukopenia secondary to CMV who had received corticosteroid therapy. The other five cases contained no inclusions and CMV antigen could not be identified by immunoperoxidase staining. This data suggests that, as with hepatitis B, viral antigen is not identifiable in acute CMV hepatitis in the immunocompetent host, perhaps due to active destruction of infected cells. The immunoperoxidase technique for CMV appears to be of little value in the diagnosis of acute CMV hepatitis.

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