Prashanth Krishna, Parimuthukumar Rajappa, Vishwanath Pai, MS, FRCS, Jayanth Leo, MS. Sri Ramachandra University, Chennai, India
Introduction: CMV Cholangitis is caused by Cytomegalovirus. It is commonly prevalent in immunocompromised group of people such as Retropositive, Organ Recipients and patients on immunosuppressant therapy. We are presenting a case of CMV Cholangitis mimicking as Periampullary carcinoma.
Case Details: 50/M came with complaints of waxing and waning jaundice for the past month associated with abdominal pain and generalised fatigue for the past two weeks. On examination, Vitals stable, Icterus noted, Epigastric tenderness present. Investigations – Total Bilirubin – 3, Direct Bilirubin 2.5, CA 19.9 – 45.5, Alkaline Phosphatase – 529, RETROPOSITIVE STATUS. CECT abdomen showed narrowing of Distal CBD with an Ampullary mass of size 2.7×2.5cm, CBD dilatation 15mm and dilatation of Hepatic ducts and IHBR. In view of the above features, Patient diagnosed to have ?Periampullary Carcinoma. Patient underwent Laparoscopic Whipple’s Procedure. Histopathology report – Dense lymphpoplasmacytic infiltration along with giant cells with inclusions in the epithelium in the stroma and in the endothelium. Cells are Vimentin positive. Large cells are positive for CMV antigen. Features suggestive of CMV Cholangitis. Patient started on Anti-Retroviral Therapy post-operatively.
Discussion: Cytomegalovirus is a DNA virus of the family Herpesviridae. Human form of CMV is Humanherpesvirus-5. CMV has a wide spectrum of disease such as CMV Retinitis, CMV Colitis, CMV Cholangitis, CMV Esophagitis, CMV Hepatitis. Diagnosis can be made by demonstrating antibodies to CMV. Culture from bodily fluids such as tears, saliva, breast milk and semen maybe used to demonstrate the virus. Histopathologically, the most characteristic feature of CMV is the presence of Intra-nuclear inclusion bodies which is called as owls eye appearance. Treatment involves the use of Ganciclovir and Valganciclovir.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 78698
Program Number: P154
Presentation Session: Poster (Non CME)
Presentation Type: Poster