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.
- portal vein
- venous thromboembolism
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Contributors CB, as first author, was partly responsible for initial conception of this work, reviewed all cited literature, wrote initial drafts of each section of the case report and made revisions in response to feedback. CT, as second author, guided the literature review process, revised initial drafts, acquired relevant clinical data and created tables and figures. KIH, as third author, revised drafts of all sections for clarity, accuracy, and for inclusion of additional intellectual content; reviewed cited literature to contribute to the analysis. JS, as last author, diagnosed the patient's CMV infection and thrombosis and was responsible for the conception and initial design of this work as the attending physician of the patient, reviewed cited literature and revised drafts for important intellectual content.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
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