Epstein–Barr Virus (EBV) Related Acute Liver Failure: A Case Series from the US Acute Liver Failure Study Group

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 revie...

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Bibliographic Details
Published in:Digestive diseases and sciences 2014-07, Vol.59 (7), p.1630-1637
Main Authors: Mellinger, Jessica L., Rossaro, Lorenzo, Naugler, Willscott E., Nadig, Satish N., Appelman, Henry, Lee, William M., Fontana, Robert J.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Antiviral agents
Antiviral Agents - therapeutic use
Bilirubin
Biochemistry
Epstein-Barr virus
Epstein-Barr Virus Infections - complications
Epstein-Barr Virus Infections - diagnosis
Epstein-Barr Virus Infections - drug therapy
Female
Gastroenterology
Hepatitis
Hepatology
Humans
Liver failure
Liver Failure, Acute - mortality
Liver Failure, Acute - surgery
Liver Failure, Acute - virology
Liver Transplantation
Male
Medical research
Medicine
Medicine & Public Health
Medicine, Experimental
Oncology
Original Article
Prospective Studies
RNA
Transplant Surgery
Transplantation of organs, tissues, etc
Treatment Outcome
United States
Young Adult
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Summary: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
ISSN:0163-2116
1573-2568
DOI:10.1007/s10620-014-3029-2