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Fulminant hepatitis due to human adenovirus

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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.

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Acknowledgments

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Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

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Authors and Affiliations

  1. Division of Pulmonary Medicine, Mayo Clinic, Phoenix, AZ, USA

    B. A. Ronan

  2. Department of Internal Medicine, Mayo Clinic, Phoenix, AZ, USA

    N. Agrwal

  3. Division of Hepatology, Mayo Clinic, Phoenix, AZ, USA

    E. J. Carey

  4. Department of Pathology, Mayo Clinic, Phoenix, AZ, USA

    G. De Petris

  5. Division of Infectious Diseases, Mayo Clinic, 5777 E. Mayo Blvd., Phoenix, AZ, 85054, USA

    S. Kusne, M. T. Seville, J. E. Blair & H. R. Vikram

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  1. B. A. Ronan
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  2. N. Agrwal
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Correspondence to H. R. Vikram.

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Ronan, B.A., Agrwal, N., Carey, E.J. et al. Fulminant hepatitis due to human adenovirus. Infection 42, 105–111 (2014). https://doi.org/10.1007/s15010-013-0527-7

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  • DOI: https://doi.org/10.1007/s15010-013-0527-7

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