Cytomegalovirus (CMV) is a clinically important pathogen in
immunocompromised patients, especially after
organ transplantation. However, there have been several
reports of severe CMV
infections in immunocompetent
patients. This
report presents a case of an immunocompetent
patient who presented with
fulminant hepatitis requiring
liver transplantation. Because CMV was detected upon histopathologic
review of the explanted
liver, it was later assumed that CMV may be the primary cause of
hepatitis. However, at the
time of
transplantation, we did not suspect CMV
hepatitis. Following
transplantation and initiation of
immunosuppression, the
patient developed viral
sepsis with a disseminated CMV
infection.
Respiratory failure because of CMV
pneumonia worsened despite
antiviral therapy, and
venovenous extracorporeal membrane oxygenation (ECMO) was initiated. Although ECMO has been traditionally contraindicated in
patients with
sepsis, this
patient recovered and was successfully weaned off ECMO. CMV should be included in the
differential diagnosis of
fulminant hepatitis, even in immunocompetent
patients, especially when
liver transplantation is considered.