TY - JOUR
T1 - Epstein-Barr Virus (EBV) related acute liver failure
T2 - A case series from the US Acute Liver Failure Study Group
AU - Mellinger, Jessica L.
AU - Rossaro, Lorenzo
AU - Naugler, Willscott E.
AU - Nadig, Satish N.
AU - Appelman, Henry
AU - Lee, William M.
AU - Fontana, Robert J.
N1 - Funding Information:
Acknowledgments We gratefully acknowledge the support provided by the members of The Acute Liver Failure Study Group. This study was funded by the National Institute of Diabetes, Digestive and Kidney Diseases (DK U-01-58369). Additional funding was provided by the Tips Fund of Northwestern Medical Foundation and the Jeanne Roberts and Rollin and Mary Ella King Funds of the Southwestern
Funding Information:
Medical Foundation. Additionally, Dr. Melllinger is supported by the T32 DK62708-01, NIDDK Training Grant in Gastrointestinal Epidemiology, and a Clinical and Translational Science Award from the Michigan Institute for Clinical and Health Research.
PY - 2014/4
Y1 - 2014/4
N2 - Purpose: Acute liver failure (ALF) is a rare clinical syndrome associated with a high case fatality rate. Asymptomatic primary infection with Epstein-Barr virus (EBV) is common in the general population while acute hepatitis and jaundice are much less common and ALF has been rarely reported. We reviewed the presenting features as well as clinical outcomes amongst consecutive adults with EBV-related ALF. Methods: Amongst the 1,887 adult ALF patients enrolled into the US ALF Study Group from January 1998 to February 2012, there were four patients (0.21 %) with EBV-related ALF. Diagnostic criteria for acute EBV infection included compatible serologies and/or the detection of EBV-encoded RNA (EBER) in liver tissue. Results: Median patient age was 30 years (range 18-44); 75 % were male, and only 25 % were immunosuppressed. The median presenting ALT was 504 IU/mL (range 156-4,920), median Alk P was 431 (range 136-1,009), and median bilirubin was 17 mg/dL (range 13-22.1). Liver biopsy findings ranged from cholestasis to submassive necrosis with EBER + staining in two of the three samples tested. Although all of the patients were treated with an antiviral agent, two died of ALF, one underwent liver transplantation (LT) and one survived with supportive care and is well at 5 years. A review of the literature identified four additional LT recipients with favorable long-term outcomes. Conclusion: Primary EBV infection accounts for <1 % of consecutive adult ALF cases but is associated with a high case fatality rate. LT is associated with favorable short- and long-term outcomes.
AB - Purpose: Acute liver failure (ALF) is a rare clinical syndrome associated with a high case fatality rate. Asymptomatic primary infection with Epstein-Barr virus (EBV) is common in the general population while acute hepatitis and jaundice are much less common and ALF has been rarely reported. We reviewed the presenting features as well as clinical outcomes amongst consecutive adults with EBV-related ALF. Methods: Amongst the 1,887 adult ALF patients enrolled into the US ALF Study Group from January 1998 to February 2012, there were four patients (0.21 %) with EBV-related ALF. Diagnostic criteria for acute EBV infection included compatible serologies and/or the detection of EBV-encoded RNA (EBER) in liver tissue. Results: Median patient age was 30 years (range 18-44); 75 % were male, and only 25 % were immunosuppressed. The median presenting ALT was 504 IU/mL (range 156-4,920), median Alk P was 431 (range 136-1,009), and median bilirubin was 17 mg/dL (range 13-22.1). Liver biopsy findings ranged from cholestasis to submassive necrosis with EBER + staining in two of the three samples tested. Although all of the patients were treated with an antiviral agent, two died of ALF, one underwent liver transplantation (LT) and one survived with supportive care and is well at 5 years. A review of the literature identified four additional LT recipients with favorable long-term outcomes. Conclusion: Primary EBV infection accounts for <1 % of consecutive adult ALF cases but is associated with a high case fatality rate. LT is associated with favorable short- and long-term outcomes.
KW - Acyclovir
KW - Fulminant hepatic failure
KW - Liver transplantation
KW - Viral hepatitis
UR - http://www.scopus.com/inward/record.url?scp=84903535599&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84903535599&partnerID=8YFLogxK
U2 - 10.1007/s10620-014-3029-2
DO - 10.1007/s10620-014-3029-2
M3 - Article
C2 - 24464209
AN - SCOPUS:84903535599
SN - 0163-2116
VL - 59
SP - 1630
EP - 1637
JO - Digestive diseases and sciences
JF - Digestive diseases and sciences
IS - 7
ER -