Abstract
Background
Portal vein thrombosis (PVT) is well recognized as a complication of hepatic cirrhosis
and is likely to be suspected in patients with hypercoagulable syndromes, however,
it is rarely recognized as a possibility in otherwise healthy patients with Epstein-Barr
virus (EBV) or cytomegalovirus (CMV) infection. We report a case of a healthy 27-year-old
man with fever and weight loss who was found to have PVT in the setting of acute EBV
and CMV infection.
Case Report
A 27-year-old man with no known medical history presented to the emergency department
(ED) for fever for 18 days. Patient reported daily high fevers associated with chills,
night sweats, generalized myalgia, nausea with appetite loss, and unquantified weight
loss. Vital signs showed temperature of 100.5°F. Patient reported discomfort upon
palpation of abdomen on physical examination. There was no lymphadenopathy, cardiac
murmur, rash, or jaundice. Laboratory tests revealed titers diagnostic of acute EBV
and CMV infection with elevated liver function tests and leukocytosis with lymphocyte
predominance (white blood cell count 15,400/μL; 43% atypical lymphocytes). Computed
tomography of the abdomen/pelvis with i.v. contrast showed a filling defect in the
anterior portal vein. The patient was admitted with the ED diagnosis of PVT secondary
to viral infection and was initiated on anticoagulation.
Why Should An Emergency Physician Be Aware of This?
Although rarely considered, CMV has been associated with PVT in up to 6% of cases,
and EBV infection has been implicated as well. Emergency physicians should be aware
of this potentially serious complication of these common viral infections and consider
imaging modalities to rule out thrombosis, if appropriate.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Emergency MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Thrombosis associated with viral hepatitis.J Clin Transl Hepatol. 2014; 2: 234-239
- Epstein-Barr virus-associated venous thromboembolism: a case report and review of the literature.Thromb Res. 2008; 122: 570-571
- Thrombosis associated with acute cytomegalovirus infection: a meta-analysis.Eur J Intern Med. 2011; 22: 195-199
- Immunoreactivation of Epstein-Barr virus due to cytomegalovirus primary infection.J Med Virol. 1998; 56: 186-191
- Serological and clinical findings in patients with serological evidence of reactivated Epstein-Barr virus infection.APMIS. 1996; 104: 424-428
Article info
Publication history
Published online: April 28, 2019
Accepted:
February 10,
2019
Received in revised form:
February 5,
2019
Received:
June 25,
2018
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
