# Cholecystitis and Cardiomyopathy in an Immunocompetent Patient With Cytomegalovirus Infection: A Case Report

## TL;DR

A 53-year-old man with no immune issues developed cholecystitis and heart issues linked to a cytomegalovirus infection.

## Contribution

Highlights CMV as a rare cause of cholecystitis and cardiomyopathy in immunocompetent individuals.

## Key findings

- CMV infection was linked to subacute cholecystitis and cardiomyopathy in an immunocompetent patient.
- Abnormal liver enzymes and fever suggested viral involvement despite no cardiac symptoms.
- Co-infection or cross-reactivity with WNV and EBV was indicated by positive serology.

## Abstract

In this case report, we present a 53-year-old immunocompetent male exhibiting cholecystitis and cardiomyopathy related to cytomegalovirus (CMV) infection. The initial presentation pointed toward cholecystitis, including epigastric pain, chronic dysgeusia, dyspepsia, and cholelithiasis on ultrasound. A cholecystectomy was performed, and tissue analysis showed subacute cholecystitis. Postsurgical daily fever spikes prompted subsequent evaluation, which revealed CMV infection along with cardiomyopathy as evidenced by a reduced left ventricular ejection fraction, despite no suggestive clinical symptoms. Gastrointestinal symptoms, along with elevated liver enzymes, indicated possible congestive hepatopathy. Preceding symptoms also suggested a viral etiology, including a protracted fever and a possible transient Bell’s palsy. Medical management for viral myocarditis was initiated, and the patient has been followed closely after discharge. The case emphasizes the importance of considering viral etiology with comprehensive cardiac workup, even in the absence of overt cardiac symptoms but with abnormal liver enzymes. Surprisingly, the infectious workup showed positive West Nile virus (WNV) and Epstein-Barr virus (EBV) serology, indicating possible co-infection or cross-reactivity.