warfarin and Cytomegalovirus-Infections

Portal vein thrombosis is an unusual condition and its association with an acute cytomegalovirus (CMV) infection is known but rarely reported. We present here the case of a 24-year-old woman suffering from a symptomatic portal vein thrombosis, confirmed by CT angiography, and acute CMV-related hepatitis. Besides a second generation oral contraceptive with estrogen and progesterone, not associated with smoking, the acute CMV infection was the only cause found to have provoked the venous thrombosis; a myeloproliferative disorder or biological thrombophilia were ruled out. The patient rapidly recovered with vitamin K antagonists (VKA) anticoagulant treatment. Eighteen cases of splanchnic vein thrombosis complicating acute CMV infection were found in the literature. All patients had acute hepatitis. The outcome was usually favorable with warfarin therapy for a period lasting 3 to 7 months. Antiviral treatment (anti-CMV) was used in three cases of severe infection. The antiviral therapy was given only in immunosuppressed patients. For immunocompetent patients, CMV infection is usually asymptomatic and clinical signs are often non-specific and mild, not requiring treatment.. This case report and the review of the literature recall the need to search for acute CMV infection in patients with portal thrombosis so a possible transient trigger for venous thromboembolism can be identified, avoiding extended anticoagulation.

Topics: Acute Disease; Anticoagulants; Contraceptives, Oral, Combined; Contraceptives, Oral, Hormonal; Cytomegalovirus Infections; Ethinyl Estradiol; Female; Heparin, Low-Molecular-Weight; Hepatitis, Viral, Human; Humans; Levonorgestrel; Portal Vein; Venous Thrombosis; Warfarin; Young Adult

We describe a young man with acute portal vein thrombosis (PVT) and cytomegalovirus (CMV) infection, and we review the literature regarding the association between PVT and CMV in immunocompetent patients. Published data suggest that CMV hepatitis and, possibly, other types of acute viral hepatitis could be a local risk factor for acute PVT.

Topics: Adult; Anticoagulants; Cytomegalovirus Infections; Enoxaparin; Heparin, Low-Molecular-Weight; Humans; Immunocompetence; Male; Portal Vein; Thrombosis; Warfarin

A previously healthy 44-year-old male presented with fever, abdominal pain, liver dysfunction and lymphadenopathy. He was diagnosed as having acute cytomegalovirus (CMV) infection with elevated CMV-IgG and IgM, and observed with supportive therapy. He was admitted to our hospital with prolonged fever lasting for a month. Enhanced CT revealed multiple thromboses in the right pulmonary artery and superior mesenteric vein. Follow-up CT after one week revealed new-onset thromboses in the left pulmonary artery and common iliac vein. Screening tests for thrombophilia were negative. His symptoms were improved with anticoagulant therapy with intravenous heparin, followed by oral warfarin. He was discharged on admission day 28 with good condition. Follow-up CT after 6 months revealed complete resolution of the thromboses. Anticoagulant therapy was stopped after 9 months, and he has been well without recurrence. Though vascular thrombosis is a rare complication, we must be alert to the signs and symptoms of thrombosis in patients with acute CMV infection.

Topics: Adult; Anticoagulants; Cytomegalovirus Infections; Humans; Male; Treatment Outcome; Venous Thrombosis; Warfarin