Acute liver injury secondary to hemophagocytic lymphohistiocytosis triggered by <scp>Epstein–Barr</scp> virus infection

Hattori, Aiji; Hamada, Yasuhiko; Kawabata, Hiroyuki; Tanaka, Kyosuke

doi:10.1002/jgh3.12439

Cited by 3 publications

(1 citation statement)

References 7 publications

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“…The most prominent pathogenic viruses that have been proposed in the trigger and initiation of liver injury include human cytomegalovirus (HCMV), Epstein-Barr-virus (EBV), influenza A virus, Hepatitis A to E, dengue virus, etc. [9][10][11][12][13][14]. Liver injury caused by SARS-CoV-2 mRNA vaccines (Pfizer-BioNTech, Oxford-AstraZeneca, and Moderna) has also been reported in many countries [6,8,15].…”

Section: Introductionmentioning

confidence: 99%

Perspective Chapter: SARS-CoV-2 Vaccine-Related Liver Failure – Active Hepatitis B and Comprehensive Literature Analysis

Yan,

Tao,

Lyu

et al. 2024

Pharmaceutical Science

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SARS-CoV-2 infection or vaccination is closely associated with liver injury, and autoimmune hepatitis episodes have been described, but liver failure has not been reported. Here, we report the case of a 41-year-old man, presenting with fatigue, anorexia after activity, greasy, decreased intake, yellow urine, and occasionally acid reflux in the stomach, occurring 2–3 weeks after receiving the first dose of inactivated SARS-CoV-2 vaccination, thought to be associated with his underlying chronic hepatitis B and fatty liver condition. The patient took the drug irregularly and did not achieve viral conversion to negative and appear rtA181T-resistant HBV mutation. Recently, the laboratory results showed abnormal liver function with high alanine aminotransferase (ALT), aspartate aminotransferase (AST), and γ-glutamyl transferase (GGT), and there was no improvement in liver function after hepatoprotective therapy, and the serum hepatitis B virus (HBV) concentration was greater than 2.0 × 106 IU/mL. Later, after being admitted to our hospital, it was found that he was in, malaise, jaundice, his eyes and sclera were yellow, his lungs were coarse breath sounds, his liver function was abnormally elevated, and his HBV virus developed a drug-resistant mutation. He has no history of autoimmune disease and tests negative for autoimmune antibodies. He became severely ill after intermittently stopping HBV treatment, worsened liver injury after inactivated SARS-CoV-2 vaccination, and was diagnosed with acute-on-chronic liver failure (ACLF). By summarizing the case report, it will provide important information on the vaccine safety assessment of vaccine components, immunization routes, and dosage for people with underlying liver disease.

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Section: Introductionmentioning

confidence: 99%

Perspective Chapter: SARS-CoV-2 Vaccine-Related Liver Failure – Active Hepatitis B and Comprehensive Literature Analysis

Yan,

Tao,

Lyu

et al. 2024

Pharmaceutical Science

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Hematologic disorders and the liver

Wentworth,

Miller,

Carlini

et al. 2025

Hepatology

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Infectious Mononucleosis: An Updated Review

Leung

Lam

Barankin³

2024

CPR

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Background: Infectious mononucleosis is common among adolescents and young adults. Although the majority of cases resolve spontaneously, life-threatening manifestations, and complications have been recognised. Objective: The purpose of this article is to familiarize clinicians with the clinical manifestations, evaluation, diagnosis, and management of infectious mononucleosis. Methods: A search was conducted in October 2022 in PubMed Clinical Queries using the key terms "infectious mononucleosis" OR “Epstein-Barr virus” OR “EBV”. The search strategy included all clinical trials, observational studies, and reviews published within the past 10 years. Only papers published in the English literature were included in this review. The information retrieved from the aforementioned search was used in the compilation of the present article. Results: Infectious mononucleosis, caused by Epstein-Barr virus, most commonly affects adolescents and adults aged 15 to 24 years. Epstein-Barr virus is transmitted primarily in saliva. Infectious mononucleosis is characterized by a triad of fever, tonsillar pharyngitis, and lymphadenopathy. Fatigue may be profound but tends to resolve within three months. Periorbital and/or palpebral edema, typically bilateral, occurs in one-third of patients. Splenomegaly and hepatomegaly occur in approximately 50% and 10% of cases, respectively. A skin rash, which is usually widely scattered, erythematous, and maculopapular, occurs in approximately 10 to 45% of cases. Peripheral blood leukocytosis is observed in most patients; lymphocytes make up at least 50% of the white blood cell differential count. Atypical lymphocytes constitute more than 10% of the total lymphocyte count. The classic test for infectious mononucleosis is the demonstration of heterophile antibodies. The monospot test is the most widely used method to detect the serum heterophile antibodies of infectious mononucleosis. When confirmation of the diagnosis of infectious mononucleosis is required in patients with mononucleosis-like illness and a negative mono-spot test, serologic testing for antibodies to viral capsid antigens is recommended. Infectious mononucleosis is a risk factor for chronic fatigue syndrome. Spontaneous splenic rupture occurs in 0.1 to 0.5% of patients with infectious mononucleosis and is potentially life-threatening. Treatment is mainly supportive. Reduction of activity and bed rest as tolerated are recommended. Patients should be advised to avoid contact sports or strenuous exercise for 8 weeks or while splenomegaly is still present. Most patients have an uneventful recovery. Conclusion: Infectious mononucleosis is generally a benign and self-limited disease. Prompt diagnosis is essential to avoid unnecessary investigations and treatments and to minimize complications. Splenic rupture is the most feared complication. As avoiding exposure to EBV is almost impossible, the most effective way to prevent EBV infection and infectious mononucleosis is the development of an effective, safe, and affordable EBV vaccine that can confer life-long immunity.

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Acute liver injury secondary to hemophagocytic lymphohistiocytosis triggered by Epstein–Barr virus infection

Cited by 3 publications

References 7 publications

Perspective Chapter: SARS-CoV-2 Vaccine-Related Liver Failure – Active Hepatitis B and Comprehensive Literature Analysis

Perspective Chapter: SARS-CoV-2 Vaccine-Related Liver Failure – Active Hepatitis B and Comprehensive Literature Analysis

Hematologic disorders and the liver

Infectious Mononucleosis: An Updated Review

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