Liver failure associated with autoimmune hepatitis in the presence of active infections by Epstein‒Barr virus and cytomegalovirus: a case report

Authors

Keywords:

liver failure; herpesvirus; autoimmunity; case report

Abstract

Background: Liver failure occurs due to extensive hepatocellular damage and may be induced by several etiologies, including autoimmunity and hepatotropic and non-hepatotropic viruses. Cytomegalovirus (CMV) and Epstein‒Barr virus (EBV) are viruses from the Herpesviridae family that usually cause latent infections but may trigger severe liver disease and dysfunction. Case presentation: Herein, we report a case of a 48-year-old female patient with jaundice, coagulopathy, encephalopathy, hyperbilirubinemia, and autoimmunity marker. The patient was referred to a public hospital in Rio de Janeiro, Brazil, and underwent a liver transplant. Serological and molecular diagnosis showed active infections by EBV and CMV. Conclusions: The presence of latent or active infection by EBV or CMV needs to be investigated in patients with liver failure of unknown etiology, which might trigger severe autoimmune hepatitis.

References

Moreau R, Jalan R, Arroyo V. Acute-on-Chronic Liver Failure: Recent Concepts. J Clin Exp Hepatol. 2015 Mar;5(1):81–5.

Ichai P, Samuel D. Epidemiology of liver failure. Clin Res Hepatol Gastroenterol. 2011 Oct;35(10):610–7.

Terziroli Beretta-Piccoli B, Mieli-Vergani G, Vergani D. Serology in autoimmune hepatitis: A clinical-practice approach. Eur J Intern Med. 2018 Feb;48:35-43.

Ichai P, Samuel D. Etiology and prognosis of fulminant hepatitis in adults. Liver Transplant Off Publ Am Assoc Study Liver Dis Int Liver Transplant Soc. 2008 Oct;14 Suppl 2:S67-79.

Kayaalp C, Ersan V, Yılmaz S. Acute liver failure in Turkey: a systematic review. Turk J Gastroenterol Off J Turk Soc Gastroenterol. 2014 Feb;25(1):35–40.

Canbay A, Tacke F, Hadem J, Trautwein C, Gerken G, Manns MP. Acute liver failure: a life-threatening disease. Dtsch Arzteblatt Int. 2011 Oct;108(42):714–20.

Dittfeld A, Gwizdek K, Michalski M, Wojnicz R. A possible link between the Epstein‒Barr virus infection and autoimmune thyroid disorders. Cent Eur J Immunol. 2016;41(3):297-301.

Wang R, Xie Z. Nonhepatotropic viral hepatitis and its causative pathogens: The ongoing need for monitoring in children with severe acute hepatitis of unknown etiology. Pediatr Investig. 2022 Aug 1;6(3):151-155.

Leiskau C, Tsaka S, Meyer-Ruhnke L, Mutschler FE, Pfister ED, Lainka E, Baumann U. Acute severe non-A-E-hepatitis of unknown origin in children - A 30-year retrospective observational study from north‒west Germany. J Hepatol. 2023 May;78(5):971-978.

Vine LJ, Shepherd K, Hunter JG, Madden R, Thornton C, Ellis V, et al. Characteristics of Epstein–Barr virus hepatitis among patients with jaundice or acute hepatitis. Aliment Pharmacol Ther. 2012 Jul 1;36(1):16–21.

Cabibi D. Autoimmune hepatitis following Epstein‒Barr virus infection. BMJ Case Rep. 2008;2008:bcr0620080071.

Mellinger JL, Rossaro L, Naugler WE, Nadig SN, Appelman H, Lee WM, et al. Epstein‒Barr virus (EBV) related acute liver failure: a case series from the US Acute Liver Failure Study Group. Dig Dis Sci. 2014 Jul;59(7):1630–7.

Busch D, Hilswicht S, Schöb DS, von Trotha KT, Junge K, Gassler N, et al. Fulminant Epstein‒Barr virus - infectious mononucleosis in an adult with liver failure, splenic rupture, and spontaneous esophageal bleeding with ensuing esophageal necrosis: a case report. J Med Case Reports. 2014 Feb 5;8:35.

Li L, Lin F, Jia Y, Liang JJ, Xu J. [Clinical features of mononucleosis because of Epstein‒Barr virus and cytomegalovirus coinfection in adult patients]. Zhonghua Yi Xue Za Zhi. 2017 Oct 24;97(39):3068–71.

Leonardsson H, Hreinsson JP, Löve A, Björnsson ES. Hepatitis due to Epstein‒Barr virus and cytomegalovirus: clinical features and outcomes. Scand J Gastroenterol. 2017 Aug;52(8):893–7.

Sassenscheidt J, Rohayem J, Illmer T, Bandt D. Detection of beta-herpesviruses in allogenic stem cell recipients by quantitative real-time PCR. J Virol Methods. 2006 Dec;138(1–2):40–8.

Gupta E, Bhatia V, Choudhary A, Rastogi A, Gupta NL. Epstein‒Barr virus associated acute hepatitis with cross-reacting antibodies to other herpes viruses in immunocompetent patients: report of two cases. J Med Virol. 2013 Mar;85(3):519–23.

Crum NF. Epstein Barr virus hepatitis: case series and review. South Med J. 2006 May;99(5):544–7.

Yu YD, Park GC, Park PJ, Choi YI, Hwang S, Song GW, et al. Cytomegalovirus infection-associated fulminant hepatitis in an immunocompetent adult requiring emergency living-donor liver transplantation: report of a case. Surg Today. 2013 Apr;43(4):424–8.

Raposo JV, Spitz N, Dos Santos DCM, Pinto MA, de Paula VS. Triple Infection by Betaherpesviruses (HCMV, HHV-6 and HHV-7) in a Child with Acute Liver Failure. Indian J Pediatr. 2021 Apr;88(4):410-411.

Sajja S, Idler J, Saad J, Bahado-Singh R. Acute liver failure in pregnancy due to autoimmune hepatitis. BMJ Case Rep. 2021 Aug 11;14(8):e241355.

Bennett JM, Glaser R, Malarkey WB, Beversdorf DQ, Peng J, Kiecolt-Glaser JK. Inflammation and reactivation of latent herpesviruses in older adults. Brain Behav Immun. 2012 Jul;26(5):739–46.

Balandraud N, Roudier J. Epstein‒Barr virus and rheumatoid arthritis. Jt Bone Spine Rev Rhum. 2017 May 9;

Suzuki M, Nagata S, Hiramatsu K, Takagi I, Ito H, Kitao S, et al. Elevated levels of soluble Fc epsilon RII/CD23 and antibodies to Epstein‒Barr virus in patients with Sjögren’s syndrome. Acta Oto-Laryngol Suppl. 1996;525:108–12.

Huppertz HI, Treichel U, Gassel AM, Jeschke R, Meyer zum Büschenfelde KH. Autoimmune hepatitis following hepatitis A virus infection. J Hepatol. 1995 Aug;23(2):204–8.

Kammer AR, van der Burg SH, Grabscheid B, Hunziker IP, Kwappenberg KM, Reichen J, et al. Molecular mimicry of human cytochrome P450 by hepatitis C virus at the level of cytotoxic T-cell recognition. J Exp Med. 1999 Jul 19;190(2):169–76.

Dittfeld A, Gwizdek K, Michalski M, Wojnicz R. A possible link between the Epstein‒Barr virus infection and autoimmune thyroid disorders. Cent Eur J Immunol. 2016;41(3):297-301.

Nystad TW, Myrmel H. Prevalence of primary versus reactivated Epstein‒Barr virus infection in patients with VCA IgG-, VCA IgM- and EBNA-1-antibodies and suspected infectious mononucleosis. J Clin Virol Off Publ Pan Am Soc Clin Virol. 2007 Apr;38(4):292–7.

Balfour HH Jr, Meirhaeghe MR, Stancari AL, Geris JM, Condon LM, Cederberg LE. Declining Epstein‒Barr Virus Antibody Prevalence in College Freshmen Strengthens the Rationale for a Prophylactic EBV Vaccine. Vaccines (Basel). 2022 Aug 26;10(9):1399.

Published

2024-12-29

How to Cite

Santos, D., Alves Pinto, M. ., Leal Corrêa, C. ., Filgueiras Pacheco-Moreira, L., & Salete de Paula, V. (2024). Liver failure associated with autoimmune hepatitis in the presence of active infections by Epstein‒Barr virus and cytomegalovirus: a case report. Estação Científica, 18(JUL./DEZ.). Retrieved from https://estacio.periodicoscientificos.com.br/index.php/estacaocientifica/article/view/2920

Issue

Section

Estudo de caso