Diagnosis: Cytomegalovirus Hepatitis after Liver Transplantation
• Microabscesses found in a liver biopsy specimen from a liver transplant recipient should prompt the pathologist to exclude cytomegalovirus (CMV) infection, including ordering CMV immunostain (which improves sensitivity over routine hematoxylin-eosin examination for intranuclear or cytoplasmic viral inclusions).
• CMV infection of the liver allograft usually occurs within the first 2 months after transplantation.
• Microabscesses from a liver transplant recipient that show no routine or immunohistochemical evidence of CMV (and are not associated with serologic or clinical evidence supporting CMV infection) should also be studied with Gomori methenamine silver stain to exclude Candida spp.
• CMV infection in a liver transplant recipient is usually acute, derived from the donor organ, or a reactivation of latent virus in the recipient.