Infection

, Volume 42, Issue 1, pp 105–111

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
Clinical and Epidemiological Study

DOI: 10.1007/s15010-013-0527-7

Cite this article as:
Ronan, B.A., Agrwal, N., Carey, E.J. et al. Infection (2014) 42: 105. doi:10.1007/s15010-013-0527-7

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.

Keywords

Adenovirus Hepatic failure Hepatitis Acute liver failure Rituximab 

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • B. A. Ronan
    • 1
  • N. Agrwal
    • 2
  • E. J. Carey
    • 3
  • G. De Petris
    • 4
  • S. Kusne
    • 5
  • M. T. Seville
    • 5
  • J. E. Blair
    • 5
  • H. R. Vikram
    • 5
  1. 1.Division of Pulmonary MedicineMayo ClinicPhoenixUSA
  2. 2.Department of Internal MedicineMayo ClinicPhoenixUSA
  3. 3.Division of HepatologyMayo ClinicPhoenixUSA
  4. 4.Department of PathologyMayo ClinicPhoenixUSA
  5. 5.Division of Infectious DiseasesMayo ClinicPhoenixUSA

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