Fulminant hepatitis due to human adenovirus

B. A. Ronan, N. Agrwal, E. J. Carey, G. De Petris, S. Kusne, M. T. Seville, J. E. Blair, H. R. Vikram

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Purpose: To describe the demographics, clinical manifestations, treatment and outcomes of patients with human adenovirus (HAdV) hepatitis. Methods: A case of fulminant HAdV hepatitis in a patient with chronic lymphocytic leukemia receiving rituximab and fludarabine is described. We conducted a comprehensive review of the English-language literature through May, 2012 in search of definite cases of HAdV hepatitis. Results: Eighty-nine cases were reviewed. Forty-three (48%) were liver transplant recipients, 19 (21%) were bone marrow transplant recipients, 11 (12%) had received chemotherapy, five (6%) had severe combined immunodeficiency, four (4%) were HIV infected, two had heart transplantation, and two were kidney transplant recipients. Ninety percent (46/51) of patients presented within 6 months following transplantation. Fever was the most common initial symptom. Abdominal CT scan revealed hypodense lesions in eight of nine patients. Diagnosis was made by liver biopsy in 43 (48%), and on autopsy in 46 (52%). The HAdV was isolated at other sites in 54 cases. Only 24 of 89 patients (27%) survived: 16 whose immunosuppression was reduced, six with liver re-transplantation, and two who received cidofovir and intravenous immunoglobulin. Conclusion: HAdV hepatitis can manifest as a fulminant illness in immunocompromised hosts. Definitive diagnosis requires liver biopsy. Early consideration of a viral etiology, reduction in immunosuppression, and liver transplantation can be potentially life-saving.

Original languageEnglish (US)
Pages (from-to)105-111
Number of pages7
JournalInfection
Volume42
Issue number1
DOIs
StatePublished - 2014

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Human Adenoviruses
Hepatitis
Liver Transplantation
Immunosuppression
Liver
X-Linked Combined Immunodeficiency Diseases
Biopsy
Severe Combined Immunodeficiency
Intravenous Immunoglobulins
Immunocompromised Host
B-Cell Chronic Lymphocytic Leukemia
Heart Transplantation
Autopsy
Fever
Language
Transplantation
Bone Marrow
Demography
HIV
Kidney

Keywords

  • Acute liver failure
  • Adenovirus
  • Hepatic failure
  • Hepatitis
  • Rituximab

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Ronan, B. A., Agrwal, N., Carey, E. J., De Petris, G., Kusne, S., Seville, M. T., ... Vikram, H. R. (2014). Fulminant hepatitis due to human adenovirus. Infection, 42(1), 105-111. https://doi.org/10.1007/s15010-013-0527-7

Fulminant hepatitis due to human adenovirus. / Ronan, B. A.; Agrwal, N.; Carey, E. J.; De Petris, G.; Kusne, S.; Seville, M. T.; Blair, J. E.; Vikram, H. R.

In: Infection, Vol. 42, No. 1, 2014, p. 105-111.

Research output: Contribution to journalArticle

Ronan, BA, Agrwal, N, Carey, EJ, De Petris, G, Kusne, S, Seville, MT, Blair, JE & Vikram, HR 2014, 'Fulminant hepatitis due to human adenovirus', Infection, vol. 42, no. 1, pp. 105-111. https://doi.org/10.1007/s15010-013-0527-7
Ronan BA, Agrwal N, Carey EJ, De Petris G, Kusne S, Seville MT et al. Fulminant hepatitis due to human adenovirus. Infection. 2014;42(1):105-111. https://doi.org/10.1007/s15010-013-0527-7
Ronan, B. A. ; Agrwal, N. ; Carey, E. J. ; De Petris, G. ; Kusne, S. ; Seville, M. T. ; Blair, J. E. ; Vikram, H. R. / Fulminant hepatitis due to human adenovirus. In: Infection. 2014 ; Vol. 42, No. 1. pp. 105-111.
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