Manifestations of Epstein‐Barr virus‐associated disorders in liver

Abstract

Epstein‐Barr virus is a ubiquitous virus associated with a variety of different diseases and disorders. The manifestations of Epstein‐Barr virus‐associated diseases or disorders within the liver, which involve a broad spectrum of histologic and clinical features, ranging from hepatitis through lymphoproliferative disorders to lymphoma, are presented. An important aspect of Epstein‐Barr virus expression and infection is the biology of the Epstein‐Barr virus. Documentation of infection can be performed using serology to detect the interaction of Epstein‐Barr virus with the immune system, and the detection of EBV proteins and use of molecular biologic techniques to identify the presence of EBV RNA, and DNA sequences. Of particular utility are in situ hybridization, Southern blot analysis, and polymerase chain reaction as diagnostic methods to identify specific RNA or DNA sequences. Epstein‐Barr virus‐associated diseases and disorders including infectious mononucleosis, sporadic fatal infectious mononucleosis, X‐linked proliferative disorder (Duncan's disease), post‐transplant lymphoproliferative disorders, lymphoma, and AIDS are discussed. The histopathologic findings present in liver associated with each disease are presented with illustrative examples. Handling the tissue and interaction with clinical services are also discussed as a method for appropriate diagnosis of Epstein‐Barr virus‐driven processes affecting the liver.

Expansion of CMV-Mediated NKG2C+ NK Cells Associates with the Development of Specific De Novo Malignancies in Liver-Transplanted Patients

“…These include, in particular, the highly prevalent herpes viruses, such as CMV and EBV, which infect at least 50 and 80%, respectively, of the adult white population (18,19). During latency, these viruses appear to be silent and cause no clinical symptoms as long as they are kept in balance with the host immune system.…”

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

“…EBV may produce a spectrum of hepatic disease. Approximately 90% of patients with EBV infection develop mild aminotransferase elevation that rarely exceeds fivefold normal levels [4,5]. In our case, the patient was immunocompetent but had aminotransferase elevations beyond 259 normal.…”

Severe acute hepatitis and cold agglutinin-related hemolytic anemia secondary to prime infection with Epstein-Barr virus

“…Although many clinical case reports describe severe EBV-associated hepatitis, an association with this type of anemia has been seldom described previously (6,7). Between 80% and 90% of patients with EBV-related mononucleosis syndrome have mild transaminase elevations, but only 5% manifest jaundice and fewer exhibit severe liver involvement (2,8,9). Similarly, the incidence of hemolytic anemia from cold agglutinins, anti-I, and anti-triphosphate isomerase antibodies (4,5) is 0.5%-3.0%, and occurs within two weeks of disease onset (10).…”

“…During childhood, the infection is usually asymptomatic or mild, but adults present with the aforementioned picture in over 50% of cases (1). Liver involvement usually occurs in 80-90% of patients with self-limiting transient disease, which manifests as mild transaminase increases < 2-3 x ULN (aspartate aminotransferase [AST], alanine aminotransferase [ALT]), whereas jaundice is much more uncommon (5%) (2). On occasions this involvement may be severe and even require liver transplantation for acute liver failure (3).…”