PEDIATRICS Vol. 87 No. 4 April 1991, pp. 556-562
This Article
Right arrow Full Text (PDF)
Right arrow P3Rs: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when P3Rs are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Marshall, G. S.
Right arrow Articles by Plotkin, S. A.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Marshall, G. S.
Right arrow Articles by Plotkin, S. A.

Protracted Mononucleosis-like Illness Associated with Acquired Cytomegalovirus Infection in a Previously Healthy Child: Transient Cellular Immune Defects and Chronic Hepatopathy

Gary S. Marshall MD1, Stuart E. Starr MD1, Camillus L. Witzleben MD1, Eva Gönczöl MD, PhD1, and Stanley A. Plotkin MD1

1 From the Division of Infectious Diseases and Department of Pathology, The Children's Hospital of Philadelphia and The Wistar Institute, Philadelphia, Pennsylvania

Ordinarily, severe disease due to acquired cytomegalovirus (CMV) infection does not occur in immunocompetent children. We describe a previously healthy boy who acquired primary CMV infection at approximately 2 years of age and experienced a 2-year-long debilitating multisystem illness from which he ultimately recovered. Clinical features of this illness included fatigue, poor weight gain, pallor, unexplained fever, musculoskeletal complaints, drenching night sweats, lymphadenopathy, and massive hepatosplenomegaly. Laboratory abnormalities included elevated erythrocyte sedimentation rate, lymphocytosis, and elevated immune complex levels. Cellular immune function was impaired during the illness but was demonstrably normal during convalescence, and there was no other evidence for a known immunodeficiency state. Immunoblot analysis showed enhanced antibody response to a 66-kd infected cell protein after symptomatic recovery. Despite consistently normal indices of hepatic function, liver enlargement persisted after other symptoms had resolved. Liver biopsy demonstrated a mononuclear cell portal tract infiltrate with fibrosis, but CMV could not be demonstrated directly in this tissue. Primary CMV infection has not been reported previously to cause the persistent symptoms seen in this child.

Key Words: cytomegalovirus • infectious mononucleosis • viral hepatitis • cellular immunity • protein-specific antibody response

Submitted on August 3, 1989
Accepted on November 30, 1989