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

26 Scopus citations

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 - Feb 2014

Keywords

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

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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