Cytomegalovirus (CMV)-associated portal vein thrombosis in a healthy, immunocompetent man

We present a previously healthy man in his 30s who presented with typical viral prodrome symptoms and worsening abdominal pain. He was found to have portal vein thrombosis, with extensive hypercoagulability workup performed. It was determined that the aetiology of thrombus was secondary to acute cytomegalovirus infection. The patient was started on anticoagulation therapy, with later clot resolution demonstrated on abdominal Doppler ultrasound and abdominal CT scan. Given the atypical presentation of this common virus, we performed a literature review of cytomegalovirus-associated portal vein thrombosis in healthy individuals; we found that most patients present with non-specific symptoms of fever and abdominal pain in the setting of a viral prodrome. This case and literature review suggest physicians must consider cytomegalovirus-associated portal vein thrombosis as a potential diagnosis when patients present with abdominal pain and viral symptoms. The literature highlights the need for a consensus on anticoagulation and antiviral therapy.

Extensive vascular thrombosis in immunocompetent patients with acute cytomegalovirus infection: a case report of a peculiar phenomenon

Background: acute Cytomegalovirus (CMV) infection in the immunocompetent usually asymptomatic or may present as a mononucleosis syndrome, but sometimes it is present as colitis, meningitis, encephalitis, or as ocular involvement and others. Thrombosis is considered an extremely rare manifestation described only in a scarce number of case reports. Case presentation: a 30-years-old immunocompetent patient present with extensive vascular thrombosis shortly after a diagnosis of CMV infectious mononucleosis was established. Other than morbid obesity, no other risk factors existed. Therapeutic anticoagulation was associated with clinical improvement. Conclusion: CMV infection can be associated with acute venous thrombosis in immunocompetent patients. An active search for both underlying prothrombotic conditions and other organ involvement sounds reasonable and should be treated, if found, accordingly.