CMV hepatiti ilişkili portal ven trombozu “olgu sunumu”

Yıl 2024, Cilt: 2 Sayı: 3, 123 - 125, 30.10.2024

Merve Kilic Tekin , Enes Erbağcı

https://doi.org/10.61845/agrimedical.1548547

Öz

Sitomegalovirüs enfeksiyonu nadiren portal ven trombozuna yol açabilir. Vakamızda sunduğumuz gibi, son yıllarda bağışıklığı yeterli bireylerde Sitomegalovirüs ilişkili tromboz vakaları dikkat çekmektedir. 31 yaşında erkek hastanın iş başvurusu öncesi rutin taramalarında alanin aminotransferaz ve aspartat aminotransferaz düzeylerinde yükseklik tespit edildi. Aktif yakınması yoktu. Portal venöz doppler incelemesinde sağ portal ven içerisinde lümeni subtotal oklüde eden ekojen trombüs materyalleri tespit edildi. Anti-CMV IgM ve IgG pozitif, trombozu açıklayacak diğer tetkikler normaldi. Anti-CMV IgG düşük avidite, CMV PCR 137 kopya/mL idi ve akut Sitomegalovirüs hepatitine sekonder portal ven trombozu olarak değerlendirildi. Antiviral tedavi uygulanmaksızın, antikoagülan tedavi ile transaminazlar normal düzeye geriledi. Kontrol portal venöz doppler incelemesinde trombüsün çözüldüğü tespit edildi. Portal ven trombozu nedeni araştırılırken hasta asemptomatik olsa da Sitomegalovirüs infeksiyonu akla gelmelidir. Sitomegalovirüs hepatiti varlığında asemptomatik vakalarda portal ven trombozu yönünden inceleme gerekebilir.

Anahtar Kelimeler

Portal ven trombozu, sitomegalovirüs, transaminaz, viroloji

CMV hepatitis related portal vein thrombosis “case report”

Öz

Cytomegalovirus infection is an uncommon etiology of portal vein thrombosis, particularly highlighted by recent cases in immunocompetent individuals. A 31-year-old male who, during routine employment screening, was found to have elevated alanine aminotransferase and aspartate aminotransferase levels, despite being asymptomatic. Doppler ultrasound revealed echogenic thrombus partially occluding the right portal vein. Laboratory tests indicated positive anti-CMV IgM and IgG, with low avidity for anti-CMV IgG, and a CMV PCR level of 137 copies/mL, suggesting portal vein thrombosis due to acute Cytomegalovirus hepatitis. The patient was treated with anticoagulation, resulting in normalization of transaminase levels, while antiviral therapy was unnecessary Follow-up Doppler imaging confirmed thrombus resolution. When investigating portal vein thrombosis, Cytomegalovirus infection should be considered, even in asymptomatic patients. In cases of Cytomegalovirus hepatitis, it is advisable to evaluate for portal vein thrombosis, including in asymptomatic individuals.

Anahtar Kelimeler

Cytomegalovirus, portal vein thrombosis, transaminase, virology

Kaynakça

• 1. Puccia F, Lombardo V, Giannitrapani L, Licata A, Mazzola G, Soresi M. Case report: acute portal vein thrombosis associated with acute cytomegalovirus infection in an immunocompetent adult. J Ultrasound. 2017;20(2):161-5.
• 2. Burkey C, Teng C, Hussein KI, Sabetta J. Cytomegalovirus (CMV)-associated portal vein thrombosis in a healthy, immunocompetent man. BMJ Case Rep. 2020;13(12):e238645.
• 3. Studahl M, Bergström T, Ekeland-Sjöberg K, Ricksten A. Detection of cytomegalovirus DNA in cerebrospinal fluid in immunocompetent patients as a sign of active infection. J Med Virol. 1995;46(3):274-80.
• 4. Centers for Disease Control and Prevention (CDC). About Cytomegalovirus. Erişim tarihi: 23 Eylül 2024. Erişim adresi: https://www.cdc.gov/cmv/clinical/overview.html
• 5. Gugliesi F, Coscia A, Griffante G, Galitska G, Pasquero S, Albano C, vd. Where do we Stand after Decades of Studying Human Cytomegalovirus? Microorganisms. 08 Mayıs 2020;8(5):685.
• 6. Rafailidis PI, Mourtzoukou EG, Varbobitis IC, Falagas ME. Severe cytomegalovirus infection in apparently immunocompetent patients: a systematic review. Virol J. 2008;5:47.
• 7. Galli L, Gerdes VEA, Guasti L, Squizzato A. Thrombosis Associated with Viral Hepatitis. J Clin Transl Hepatol. 2014;2(4):234-9.
• 8. Tichelaar VYIG, Sprenger HG, Mäkelburg ABU, Niesters BGM, Kluin-Nelemans HC, Lijfering WM. Active cytomegalovirus infection in patients with acute venous thrombosis: a casecontrol study. Am J Hematol. 2011;86(6):510-2.
• 9. Justo D, Finn T, Atzmony L, Guy N, Steinvil A. Thrombosis associated with acute cytomegalovirus infection: a meta-analysis. Eur J Intern Med. 2011;22(2):195-9.
• 10. Squizzato A, Gerdes VEA, Büller HR. Effects of human cytomegalovirus infection on the coagulation system. Thromb Haemost. 2005;93(3):403-10.
• 11. Centers for Disease Control and Prevention (CDC). Laboratory Testing for CMV and Congenital CMV. Erişim tarihi 23 Eylül 2024. Erişim adresi: https://www.cdc.gov/cytomegalovirus/php/ laboratories/index.html
• 12. Deconinck L, Flateau C, Pichenot M, Morell-Dubois S, Maillard H, Hatron PY, et al. Antiviral therapy of primary cytomegalovirus infection with vascular thrombosis in immunocompetent adults. Med Mal Infect. 2016;46(2):87-92.
• 13. Pichenot M, Morell-Dubois S, Flateau C, Deconinck L, Hatron PY, Lambert M. Acute cytomegalovirus infection as a transient risk factor for thrombosis: report of three cases and focus on specific coagulation pathways. Thromb Res. 2013;132(1):145-7.