Hashimoto's encephalopathy after interferon therapy for hepatitis C virus in adult liver transplant recipient accompanied by post-transplant lymphoproliferative disorder related to Epstein-Barr virus infection: Case report

T. Hori, F. Oike, K. Hata, M. Nishikiori, Y. Ogura, K. Ogawa, Y. Takada, H. Egawa, Justin H Nguyen, S. Uemoto

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

A 55-year-old woman underwent living-donor liver transplantation (LDLT). She had no history of autoimmune diseases. Spleen was preserved. Steroids were withdrawn at 3 months after LDLT. Epstein-Barr virus (EBV) infection occurred at 3.5 years after LDLT. Recurrent hepatitis C virus infection was confirmed at 4.5 years after LDLT, and pegylated interferon was introduced. Diagnosis of EBV-positive post-transplant lymphoproliferative disorder (PTLD) was made at 4.8 years after LDLT, and tacrolimus (Tac) was stopped completely. Then, unconsciousness, convulsion, and cervical stiffness appeared suddenly. Electroencephalography, cerebrospinal fluid analysis, and image studies revealed normal or only nonspecific findings. The patient was in a state of exhaustion; therefore, steroid pulse therapy (SPT) was attempted. Surprisingly, her general condition, including consciousness disturbance, was improved markedly, and Hashimoto's encephalopathy (HE) was suspected, based on this reaction to SPT. Elevations of anti-thyroglobulin antibody and anti-thyroid peroxidase antibody were confirmed. After withdrawal of Tac, and treatment with acyclovir and steroids, EBV-positive PTLD and HE improved, although they recurred at 5.1 years after LDLT. SPT improved only neurological symptoms. Molecular-targeted therapy was given for recurrent PTLD, based on analysis of sampling specimens. This therapy was effective, but tumor lysis syndrome occurred, and the patient died at 5.3 years after LDLT.

Original languageEnglish (US)
Pages (from-to)347-352
Number of pages6
JournalTransplant Infectious Disease
Volume12
Issue number4
DOIs
StatePublished - Aug 2010

Fingerprint

Epstein-Barr Virus Infections
Lymphoproliferative Disorders
Living Donors
Hepacivirus
Liver Transplantation
Interferons
Transplants
Liver
Steroids
Tacrolimus
Human Herpesvirus 4
Therapeutics
Tumor Lysis Syndrome
Molecular Targeted Therapy
Iodide Peroxidase
Unconsciousness
Acyclovir
Virus Diseases
Transplant Recipients
Hashimoto's encephalitis

Keywords

  • Epstein-Barr virus
  • Hashimoto's encephalopathy
  • hepatitis C virus
  • interferon
  • liver transplantation
  • post-transplant lymphoproliferative disorder

ASJC Scopus subject areas

  • Transplantation
  • Infectious Diseases

Cite this

Hashimoto's encephalopathy after interferon therapy for hepatitis C virus in adult liver transplant recipient accompanied by post-transplant lymphoproliferative disorder related to Epstein-Barr virus infection : Case report. / Hori, T.; Oike, F.; Hata, K.; Nishikiori, M.; Ogura, Y.; Ogawa, K.; Takada, Y.; Egawa, H.; Nguyen, Justin H; Uemoto, S.

In: Transplant Infectious Disease, Vol. 12, No. 4, 08.2010, p. 347-352.

Research output: Contribution to journalArticle

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abstract = "A 55-year-old woman underwent living-donor liver transplantation (LDLT). She had no history of autoimmune diseases. Spleen was preserved. Steroids were withdrawn at 3 months after LDLT. Epstein-Barr virus (EBV) infection occurred at 3.5 years after LDLT. Recurrent hepatitis C virus infection was confirmed at 4.5 years after LDLT, and pegylated interferon was introduced. Diagnosis of EBV-positive post-transplant lymphoproliferative disorder (PTLD) was made at 4.8 years after LDLT, and tacrolimus (Tac) was stopped completely. Then, unconsciousness, convulsion, and cervical stiffness appeared suddenly. Electroencephalography, cerebrospinal fluid analysis, and image studies revealed normal or only nonspecific findings. The patient was in a state of exhaustion; therefore, steroid pulse therapy (SPT) was attempted. Surprisingly, her general condition, including consciousness disturbance, was improved markedly, and Hashimoto's encephalopathy (HE) was suspected, based on this reaction to SPT. Elevations of anti-thyroglobulin antibody and anti-thyroid peroxidase antibody were confirmed. After withdrawal of Tac, and treatment with acyclovir and steroids, EBV-positive PTLD and HE improved, although they recurred at 5.1 years after LDLT. SPT improved only neurological symptoms. Molecular-targeted therapy was given for recurrent PTLD, based on analysis of sampling specimens. This therapy was effective, but tumor lysis syndrome occurred, and the patient died at 5.3 years after LDLT.",
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AU - Nguyen, Justin H

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