Noncirrhotic Portal Hypertension in Congenital Cytomegalovirus Infection

The majority of infants with cytomegalovirus hepatitis have resolution of the disease with little evidence of fibrosis; there are only rare instances of cirrhosis. We report an infant with cytomegalovirus hepatitis who developed portal hypertension and hematemesis at 3 months of age. Liver biopsy showed resolution of the hepatitis but the presence of noncirrhotic sinusoidal fibrosis. Because of recurrent hematemesis in spite of sclerosing therapy on two occasions, the beta antagonist propranolol was begun. Hepatic wedge pressures before and after treatment with propranolol were 13 and 7 mm Hg, respectively. The findings emphasize: (i) that cytomegalovirus hepatitis may result in noncirrhotic sinusoidal fibrosis and (ii) that propranolol may be beneficial in the management of portal hypertension secondary to noncirrhotic sinusoidal fibrosis.