Portal Vein Thrombosis Due to Concomitant Cytomegalovirus and Epstein-Barr Virus Infection: An Underestimated Complication.

BACKGROUND Non-cirrhotic non-malignant portal vein thrombosis (PVT) is considered a rare disorder in patients without a risk of thrombophilia. Acute viral infection has been reported to be associated with an increased risk of venous thromboembolism more often in immunocompromised patients. CASE REPORT We hereby present a case of a young man who presented to the hospital with fever, fatigue, and vague abdominal pain. An initial investigation showed mild elevation in liver enzymes, and an ultrasound of the abdomen revealed mild hepatosplenomegaly. The serological test for cytomegalovirus (CMV) and Epstein-Barr virus (EBV) revealed high titers of immunoglobulin M (IgM). The IgG titers for both viruses were negative, suggesting a recent acute infection. A computed tomography (CT) scan of the abdomen demonstrated acute PVT. The patient was shifted to the ICU, and anticoagulation was initiated immediately with unfractionated heparin (intravenous bolus of 80 u/kg followed by 18 u/kg/hr, target aPTT of 1.5-2.3 control). A thorough workup was performed to exclude primary and secondary causes of PVT; all tests were negative. A diagnosis of acute PVT secondary to CMV and EBV infection was made. The patient's symptoms gradually improved, and he was discharged home on oral anticoagulation. CONCLUSIONS Acute CMV and/or EBV infection is associated with the risk of thromboembolism even in immunocompetent patients. Treating it as a provoked risk for thromboembolism will aid in its early detection and management. Additionally, by treating it as a triggered risk, unnecessary lifelong anticoagulation can be avoided.