This patient’s presentation may simply haveresulted from CMV infection in the context of NAFLD, but given his immunocompetentstatus, the absence of lymphadenopathy, the limitations of CMV IgM in acuteinfection, and the lack of leukocytosis with lymphocytic shift, other diagnosesdeserve consideration.7 This evidence concerns the gene CD40LG and cytomegalovirus infection.