Epstein–Barr Virus (EBV) Related Acute Liver Failure: A Case Series from the US Acute Liver Failure Study Group (original) (raw)
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Fulminant hepatitis due to Epstein-Barr virus infection
Journal of Hepatology, 1995
Epstein-Barr virus infection is a benign disease, which may occasionally be fatal, particularly in children. Epstein-Barr virus infection is rare in elderly subjects and appears to have a self-limited course. An unusual case of fulminant hepatitis due to primary Epstein-Barr virus infection in a 62-year-old male 18 days after a cardiosurgical operation and blood transfusions is described in the present paper. Post-mortem examination of the liver showed massive hepatic necrosis. The etiology was established by increase in IgM antibodies to Epstein-Barr virus (titer 1:3.120) in serum and by cellular expression of Epstein-Barr virus DNA in liver tissue.
Acute hepatitis induced by Epstein-Barr virus infection: a case report
The Turkish journal of gastroenterology : the official journal of Turkish Society of Gastroenterology, 2007
Epstein-Barr virus is a causative agent of infectious mononucleosis syndrome, which is commonly seen in young adults and characterized by fever, sore throat and lymphadenopathy. In adults, Epstein-Barr virus infection can cause liver function test abnormalities without pharyngitis or lymphadenopathy. Liver involvement usually causes mild elevation of transaminases and this abnormality resolves spontaneously. Jaundice might develop rarely during the clinical course of Epstein-Barr virus infection. It reflects either more severe hepatitis or Epstein-Barr virus infection-associated hemolytic anemia. Acute hepatitis with icterus is a rare clinical manifestation in primary Epstein-Barr virus infection. Especially in older patients, Epstein-Barr virus infection can cause cholestasis; the diagnosis can be established by elimination of extrahepatic biliary obstruction. Here we report an acute hepatitis in a patient who presented with icterus and was diagnosed as acute Epstein-Barr virus inf...
Acute hepatitis: a rare complication of Epstein-Barr virus (EBV) infection
The Journal of Infection in Developing Countries, 2010
Infectious Mononucleosis (IM), a benign lymphoproliferative disease, is the best known clinical syndrome caused by Epstein-Barr Virus (EBV). It usually resolves over a period of weeks or months without sequelae but may occasionally be complicated by a wide variety of neurologic, hematologic, hepatic, respiratory, and psychological complications. In this report we describe a patient with acute hepatitis following EBV-IM in a previously healthy woman. A 26-year-old woman who presented with fever, generalized weakness, nausea, sore throat, yellowing of skin, and a generalized skin rash was admitted to our clinic. Tonsillar enlargement, pharyngeal erythema, palatal petechiae, lymphadenopathy, and jaundice were noted. Significant atypical lymphocytes ( > 10%) were seen on the peripheral blood smear. Liver function tests such as ALT: 303 U/L, AST: 172 U/L, ALP: 193 U/L and total bilirubin: 7.3 mg/dl were elevated. Serological tests for EBV infection were consistent with acute infection (EBV virus capsid antigen was reactive with IgM and IgG antibodies). The Monospot test was also positive. On the seventh day, liver function tests and bilirubin had risen to peak level and platelets were decreased. The patient was managed supportively and her critical condition improved and was finally stabilized. Although the prognosis for IM is very favorable, a variety of acute complications may occur.
The role of Epstein–Barr virus in acute and chronic hepatitis
Journal of Hepatology, 2006
Background/Aims: Epstein-Barr virus has a seroprevalence of more than 80% world wide and is known to be associated with hepatitis. However, little is known about the underlying pathogenesis and immunmechanisms and no standard diagnostic criteria to diagnose EBV-hepatitis are available.
European Journal of Internal Medicine, 2011
Objectives: Epstein-Barr Virus (EBV) infection has the potential to establish life-long, benign infections in their hosts. Although biochemical evidence of hepatocellular damage is common, jaundice is uncommon and complete recovery is the rule. The present study describes clinical characteristics and changes of liver function tests during the course of infectious mononucleosis. Patients and methods: All immunocompetent patients with hepatic dysfunction associated with acute EBV infection, cared for at the University Hospital of Heraklion, over a 6-year period, were identified and retrospectively studied. Results: The study included 41 patients with a median age of 18.5 (15-51) years. Aspartate-aminotrasferase (AST) and alanine-aminotrasferase (ALT) were increased in an average maximum of 5-fold. Both transaminase levels started to rise 2 days after the clinical onset of the disease, and returned to normal after a period of 20 days. Alkaline-phosphatase (ALP), γ-glutamyltransferase (γ-GT) and bilirubin levels also increased above the normal values during the course of the disease and returned to normal after a period of 20, 30 and 22 days respectively. The changes of mean AST and ALT levels over time were statistically significant, while those of mean ALP, γ-GT and bilirubin levels over time were not. Anicteric cholestatic liver disease was observed in 24 patients (59%), while icteric only in 2 (6%). Conclusion: Liver involvement in acute EBV infection represents mild and self-limited hepatitis with predominantly cholestatic features.
Author's personal copy Epstein Barr Virus hepatitis
Objectives: Epstein-Barr Virus (EBV) infection has the potential to establish lifelong , benign infections in their hosts. Although biochemical evidence of hepatocellular damage is common, jaundice is uncommon and complete recovery is the rule. The present study describes clinical characteristics and changes of liver function tests during the course of infectious mononucleosis. Patients and methods: All immunocompetent patients with hepatic dysfunction associated with acute EBV infection, cared for at the University Hospital of Heraklion, over a 6-year period, were identified and retrospectively studied. Results: The study included 41 patients with a median age of 18.5 (15-51) years. Aspartate-aminotrasferase (AST) and alanine-aminotrasferase (ALT) were increased in an average maximum of 5-fold. Both transaminase levels started to rise 2 days after the clinical onset of the disease, and returned to normal after a period of 20 days. Alkaline-phosphatase (ALP), γ-glutamyltransferase (γ-GT) and bilirubin levels also increased above the normal values during the course of the disease and returned to normal after a period of 20, 30 and 22 days respectively. The changes of mean AST and ALT levels over time were statistically significant, while those of mean ALP, γ-GT and bilirubin levels over time were not. Anicteric cholestatic liver disease was observed in 24 patients (59%), while icteric only in 2 (6%). Conclusion: Liver involvement in acute EBV infection represents mild and self-limited hepatitis with predominantly cholestatic features.
Etiology and outcome of patients with viral-induced acute liver failure
International Journal of Research in Medical Sciences
Background: Acute liver failure (ALF) is a rare medical emergency and devastating clinical syndrome associated with high mortality in the absence of immediate intensive supportive care, specific treatment, or liver transplantation. Viral hepatitis is still one of the main causes of ALF in the India as well in world. We aimed to determine the etiology of Viral-ALF and to compare the outcome and clinical and biochemical variables in patients with hepatitis E and non HEV group in this prospective study.Methods: A total of 37 patients with a diagnosis of viral-ALF were included in the study. The variables evaluated were demographic, signs and symptoms, biochemical parameters, severity of liver injury, outcome, complications and duration of hospital stay.Results: Out of 37 Viral-ALF patients, Acute HEV-induced ALF (48.6%) was most common followed by HBV (24.3%) and HAV (21.6%). There were significantly more females in HEV group (61.1%) than non HEV group (21.1%) (P = 0.014). Overall mort...
Epstein-Barr virus: Silent companion or causative agent of chronic liver disease?
World Journal of Gastroenterology, 2010
The Epstein-Barr virus (EBV) has an important and multifaceted role in liver pathology. As a member of the herpes virus family, EBV establishes a persistent infection in more than 90% of adults. Besides acute hepatitis during primary infection, many clinical syndromes of interest for the hepatologist are associated with EBV infection. The role of EBV in the evolution of chronic hepatitis from hepatotropic viruses is considered. Chronic EBVassociated hepatitis is suspected in immunocompetent adults with compatible serology, suggestive histology and detection of the viral genome in the liver and/or increase of specific circulating cytotoxic T-lymphocytes. EBV is the main cause of post-transplant lymphoproliferative disorders which occur in up to 30% of cases. EBV-driven lymphoproliferative diseases are also recognized in non-immunocompromised patients and liver is involved in up to a third of the cases. Directly implicated in the pathogenesis of different tumors, EBV has a disputable role in hepatocellular carcinoma carcinogenesis. Further research is required in order to establish or reject the role of EBV in human liver cancer. This paper attempts to discuss the range of EBV-associated chronic liver diseases in immunocompetent patients, from mild, self-limiting mononuclear hepatitis to liver cancer.
Chronic Epstein-Barr virus-related hepatitis in immunocompetent patients
World journal of gastroenterology : WJG, 2006
To investigate reactivated Epstein-Barr virus (EBV) infection as a cause for chronic hepatitis. Patients with occasionally established elevated serum aminotransferases were studied. HIV, HBV and HCV-infections were excluded as well as any other immunosuppressive factors, metabolic or toxic disorders. EBV viral capsid antigen (VCA) IgG and IgM, EA-R and EA-D IgG and Epstein-Barr nuclear antigen (EBNA) were measured using IFA kits. Immunophenotyping of whole blood was performed by multicolor flow cytometry. CD8(+) T cell responses to EBV and PHA were determined according to the intracellular expression of IFN-gamma. The mean alanine aminotransferase (ALT) and gamma glutamyl transpeptidase (GGTP) values exceeded twice the upper normal limit, AST/ALT ratio < 1. Serology tests showed reactivated EBV infection in all patients. Absolute number and percentages of T, B and NK cells were within the reference ranges. Fine subset analysis, in comparison to EBV(+) healthy carriers, revealed a...
Viral Hepatitis-Related Acute Liver Failure
Amer J Gastroenterol, 2003
OBJECTIVES: Viral hepatitis has previously been the major cause of acute liver failure (ALF) in the United States. We aimed to determine the incidence of viral hepatitis-related ALF and to compare the outcome and clinical and biochemical variables in patients with hepatitis A and B. METHODS: A total of 354 patients with ALF from multiple centers were screened for possible acute viral etiology. RESULTS: Forty-three patients (12.1% of all ALF cases) had acute viral hepatitis: hepatitis A (n ϭ 16), hepatitis B (n ϭ 26), and herpes simplex virus infection (n ϭ 1). There was no difference between groups with regard to age, gender, body mass index, admission or peak coma grade, symptom duration, admission mean arterial pressure, temperature, or biochemical liver tests, creatinine, arterial pH, or rate of infections. Platelet count was significantly higher in hepatitis A patients than in hepatitis B patients. The transplantation-free (spontaneous) survival rate was significantly higher for hepatitis A patients (69%) than for hepatitis B patients (19%, p ϭ 0.007), whereas the liver transplantation rate was higher in hepatitis B patients (62%) than in hepatitis A patients (19%, p ϭ 0.017). Spontaneous survivors had significantly higher mean arterial pressure, higher platelet count, and lower AST/ALT ratio than patients who did not survive spontaneously. CONCLUSIONS: Viral hepatitis now comprises only oneeighth of all ALF cases in the United States. The marked difference in spontaneous survival between hepatitis A and B cannot be explained by the severity of hepatic dysfunction on admission but may rather be an inherent feature of the infections or a bias toward transplanting patients with hepatitis B.