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

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

Revised: 3 November 2017, last major update May 2016

Copyright: (c) 2002-2017, PathologyOutlines.com, Inc.

PubMed Search: Cytomegalovirus hepatitis[TI]
Cite this page: Mannan, A.A.S.R. Cytomegalovirus hepatitis (CMV). PathologyOutlines.com website. http://pathologyoutlines.com/topic/liverCMV.html. Accessed December 16th, 2017.
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

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Classical CMV cytopathic effect


Neutrophilic microabscess in acute CMV hepatitis

Microgranuloma associated with CMV hepatitis

CMV immuno-histochemistry

Positive stains
Differential diagnosis