GENERALIZED CYTOMEGALOVIRUS INFECTION IN A PATIENT WITH LUPOID HEPATITIS

SUMMARY A woman aged 18 years had an acute “multisystem disease” of which the major impact was on the liver; the LE cell test was positive. The subsequent course of the illness was that of “autoimmune” lupoid hepatitis: serological tests for antinuclear and smooth muscle antibody were positive, and continued treatment with prednisolone was necessary. Splenectomy was required for thrombocytopenia with bruising. Liver biopsy during the illness showed quiescent hepatitis and no virus inclusions in liver cells. After seven years of illness and two years of treatment with azathioprine, a fatal febrile illness occurred with sharp deterioration of liver function. Autopsy revealed inclusions of cytomegalovirus in liver cells and many other tissues. The discussion is concerned with cytomegalovirus as a cause of liver disease in adults, “latent” cytomegalovirus infection, and the degree to which immunosuppressive therapy in this case predisposed to the fatal illness due to cytomegalovirus.