A case of rapid deterioration from acute liver failure possibly due to Epstein-Barr virus reactivation

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  • Yamamoto Eriko
    Department of Gastroenterology and Hepatology, Kansai Medical University Medical Center Department of Gastroenterology and Hepatology, Kansai Medical University
  • Murata Miki
    Department of Gastroenterology and Hepatology, Kansai Medical University Medical Center Department of Gastroenterology and Hepatology, Kansai Medical University
  • Yamashiki Noriyo
    Department of Gastroenterology and Hepatology, Kansai Medical University Medical Center Department of Gastroenterology and Hepatology, Kansai Medical University
  • Yamashina Masao
    Department of Gastroenterology and Hepatology, Kansai Medical University Medical Center Department of Gastroenterology and Hepatology, Kansai Medical University
  • Suwa Kanehiko
    Department of Gastroenterology and Hepatology, Kansai Medical University Medical Center Department of Gastroenterology and Hepatology, Kansai Medical University
  • Tsuyumu Keiko
    Department of Emergency Medicine, Kansai Medical University Medical Center
  • Yoshiya Kazuhisa
    Department of Emergency Medicine, Kansai Medical University Medical Center
  • Nakamori Yasushi
    Department of Emergency Medicine, Kansai Medical University Medical Center
  • Shimatani Masaaki
    Department of Gastroenterology and Hepatology, Kansai Medical University Medical Center Department of Gastroenterology and Hepatology, Kansai Medical University
  • Seki Toshihito
    Liver Disease Center, Kansai Medical University Medical Center
  • Naganuma Makoto
    Department of Gastroenterology and Hepatology, Kansai Medical University

Bibliographic Information

Other Title
  • 急激に進行し後にEpstein-Barrウイルス再活性化の関与が疑われた急性肝不全昏睡型の一例
  • キュウゲキ ニ シンコウ シ アト ニ Epstein-Barr ウイルス サイカッセイカ ノ カンヨ ガ ウタガワレタ キュウセイ カンフゼン コンスイガタ ノ イチレイ

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Abstract

<p>A woman in her late teens was being treated with prednisolone and azathioprine for autoimmune demyelinated disorder when she developed drug erythema 2 weeks before admission. Her skin symptoms improved after the drug was discontinued; however, she developed fever and nausea within a week. Laboratory tests revealed that her liver enzymes were elevated, and she was admitted to our department for acute liver injury. Serological tests revealed no evidence of viral hepatitis, and drug-induced liver damage was suspected. On the 8th hospital day, she developed hepatic encephalopathy with a PT-INR of 2.32. Steroid pulse therapy and continuous hemodiafiltration were initiated for acute liver failure (ALF) and she was placed on the waiting list for liver transplantation. Despite intensive treatment, she developed irreversible brain edema on the 10th hospital day. We later discovered that serum EBV-DNA (3.3 LogIU/mL) was positive. EBV infection is a rare but severe cause of ALF in adults. Thus, EBV reactivation should be considered in the differential diagnosis of ALF from an unknown cause.</p>

Journal

  • Kanzo

    Kanzo 64 (9), 445-451, 2023-09-01

    The Japan Society of Hepatology

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