Acute Hepatitis Due to Epstein–Barr Virus in an Immunocompetent Patient

Pagidipati, Neha J.; Obstein, Keith L.; Rucker-Schmidt, Rachel; Odze, Robert D.; Thompson, Christopher C.

doi:10.1007/s10620-009-0835-z

Cited by 8 publications

(6 citation statements)

References 16 publications

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“…Acute severe hepatitis in young, immunocompetent patients has also been previously reported [24, 25]. In some of the larger case series describing EBV hepatitis, a cholestatic pattern is seen in 65 % of patients and the disease course is usually mild and self-limited [8].…”

Section: Discussionmentioning

confidence: 86%

Epstein–Barr Virus (EBV) Related Acute Liver Failure: A Case Series from the US Acute Liver Failure Study Group

et al. 2014

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Purpose Acute liver failure (ALF) is a rare clinical syndrome associated with a high case fatality rate. Asymptomatic primary infection with Epstein–Barr virus (EBV) is common in the general population while acute hepatitis and jaundice are much less common and ALF has been rarely reported. We reviewed the presenting features as well as clinical outcomes amongst consecutive adults with EBV-related ALF. Methods Amongst the 1,887 adult ALF patients enrolled into the US ALF Study Group from January 1998 to February 2012, there were four patients (0.21 %) with EBV-related ALF. Diagnostic criteria for acute EBV infection included compatible serologies and/or the detection of EBV-encoded RNA (EBER) in liver tissue. Results Median patient age was 30 years (range 18–44); 75 % were male, and only 25 % were immunosuppressed. The median presenting ALT was 504 IU/mL (range 156–4,920), median Alk P was 431 (range 136–1,009), and median bilirubin was 17 mg/dL (range 13–22.1). Liver biopsy findings ranged from cholestasis to submassive necrosis with EBER + staining in two of the three samples tested. Although all of the patients were treated with an antiviral agent, two died of ALF, one underwent liver transplantation (LT) and one survived with supportive care and is well at 5 years. A review of the literature identified four additional LT recipients with favorable long-term outcomes. Conclusion Primary EBV infection accounts for <1 % of consecutive adult ALF cases but is associated with a high case fatality rate. LT is associated with favorable short- and long-term outcomes.

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Section: Discussionmentioning

confidence: 86%

Epstein–Barr Virus (EBV) Related Acute Liver Failure: A Case Series from the US Acute Liver Failure Study Group

et al. 2014

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“…119 Phlebotomy has been shown to improve or normalize liver enzyme abnormalities in these patients. 122,123 Liver infection by other herpes viruses, adenovirus, and bacteria and fungi, may occur following HCT, but the morphologic changes associated with such infections would not be expected to cause confusion with GVHD. 121 Although HCT patients are susceptible to liver infection due to opportunistic and other organisms, unlike in the GI tract, the morphologic changes occurring in this setting do not usually mimic those related to GVHD.…”

Section: Iron Overloadmentioning

confidence: 99%

Hematopoietic Stem Cell Transplantation

Kambham

Higgins

Sundram

et al. 2014

Advances in Anatomic Pathology

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Hematopoietic stem cell transplantation (HCT), formerly known as bone marrow transplantation, is an integral part of treatment for many hematological malignancies. HCT is associated with several complications and comorbidities with differential effects on a wide spectrum of organs and tissues. We present an update on HCT-associated complications such as graft versus host disease (GVHD) and infection, with focus on the surgical pathology of the gastrointestinal (GI) tract, liver, and lung. Although the grading system for GI tract acute GVHD was proposed 40 years ago, recent studies have shed light on minimal histologic criteria for diagnosis of GVHD, as well as its differential diagnosis, including histologic effects of various medications. GI dysfunction in autologous transplant recipients is increasingly appreciated and patients are often biopsied. Acute liver injury in HCT is often due to sinusoidal obstruction syndrome (previously known as venoocclusive disease), or acute GVHD. Liver dysfunction at later time posttransplantation may be associated with acute or chronic GVHD, iron overload, or other causes of hepatitis. Lung injury in HCT is multifactorial, and it remains crucially important to diagnose and treat pulmonary infections. The pulmonary biopsy yields clinically unsuspected diagnoses in the majority of cases and its utilization is likely to increase. The pathology of the skin and kidney in HCT patients are detailed in accompanying articles.

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“…EBV is known to cause acute hepatitis, although the degree of elevation of serum ALT or bilirubin is typically mild. [11][12][13] Occasionally EBV results in overt cholestatic hepatitis, [14][15][16][17][18][19][20] and there is one noteworthy report of a 15-year-old with HbSC disease who developed EBVinduced cholestatic hepatitis without sickle hepatopathy (maximum serum ALT and total bilirubin of 770 U/L and 12.5 mg/dL, respectively). 21 We posit that the marked serum ALT elevation seen in Patient 1, which is not typical of hepatic sequestration crisis (Table 1), partly reflected EBV-induced hepatitis.…”

Section: Discussionmentioning

confidence: 99%

Epstein-Barr virus induced sickle hepatopathy

Towerman

Wilson

Hulbert

2021

Preprint

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Sickle hepatopathy comprises a spectrum of disorders that vary in severity. Intravascular sickling and sinusoidal occlusion are the principal drivers of sickle hepatopathy, but infection or autoimmunity may act as triggers. We describe two cases of acute sickle hepatopathy initiated by primary Epstein-Barr virus (EBV) infection, a previously unreported association. The first case entailed a 14-year-old girl with hemoglobin SC (HbSC) disease who developed hepatic sequestration crisis that responded to a simple transfusion of erythrocytes. The second case was that of a 16-year-old boy with HbSC disease who experienced life-threatening intrahepatic cholestasis with multi-organ failure.

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Acute Hepatitis Due to Epstein–Barr Virus in an Immunocompetent Patient

Cited by 8 publications

References 16 publications

Epstein–Barr Virus (EBV) Related Acute Liver Failure: A Case Series from the US Acute Liver Failure Study Group

Epstein–Barr Virus (EBV) Related Acute Liver Failure: A Case Series from the US Acute Liver Failure Study Group

Hematopoietic Stem Cell Transplantation

Epstein-Barr virus induced sickle hepatopathy

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