Epstein-Barr Virus-Related Hyperacute Hepatitis: May Intravenous Steroids be an Effective Approach?
Background: Severe acute liver failure by Epstein-Barr virus is a rare event. A specific antiviral treatment is not available and steroid use is controversial. <p></p> Objective: We report the beneficial effect of steroid therapy in this clinical condition. <p></p> Case Report: We observed the case of a 19-year male patient admitted to our Gastroenterology Unit for an acute Epstein-Barr virus-related hepatitis (significant transaminase flare: aspartate transaminase x 91 and alanine transaminase x 56 the upper limit of normal, Model for End-stage Liver Disease: MELD score 14). A severe liver injury occurred about 20 days after onset (MELD score 29). A prompt dramatic improvement of liver damage markers was achieved after eight-day methylprednisolone intravenous administration (MELD score 9) despite viral disappearance (i.e. absence of EBV-DNA in blood and nasopharyngeal swab) occurred after 6 months. Anti-EBV IgM positivity was observed at the 14th month despite presence of specific IgG (“past infection, IgM persisting”). <p></p> Conclusion: Therapeutic response suggests that the short-term use of steroids, even if not recommended for routine treatment of infectious mononucleosis, may be effective to treat the immunemediated symptoms. Possible steroid interactions with the host immune-response to the virus have not been demonstrated in short-term administration. Our case suggests focusing on this last topic. <p></p>.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2017 |
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| Erschienen: |
2017 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:15 |
|---|---|
| Enthalten in: |
Anti-infective agents - 15(2017), 1, Seite 15-19 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Shahini, Endrit [VerfasserIn] |
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| Links: |
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| Förderinstitution / Projekttitel: |
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OLC2000014593 |
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| 520 | |a Background: Severe acute liver failure by Epstein-Barr virus is a rare event. A specific antiviral treatment is not available and steroid use is controversial. <p></p> Objective: We report the beneficial effect of steroid therapy in this clinical condition. <p></p> Case Report: We observed the case of a 19-year male patient admitted to our Gastroenterology Unit for an acute Epstein-Barr virus-related hepatitis (significant transaminase flare: aspartate transaminase x 91 and alanine transaminase x 56 the upper limit of normal, Model for End-stage Liver Disease: MELD score 14). A severe liver injury occurred about 20 days after onset (MELD score 29). A prompt dramatic improvement of liver damage markers was achieved after eight-day methylprednisolone intravenous administration (MELD score 9) despite viral disappearance (i.e. absence of EBV-DNA in blood and nasopharyngeal swab) occurred after 6 months. Anti-EBV IgM positivity was observed at the 14th month despite presence of specific IgG (“past infection, IgM persisting”). <p></p> Conclusion: Therapeutic response suggests that the short-term use of steroids, even if not recommended for routine treatment of infectious mononucleosis, may be effective to treat the immunemediated symptoms. Possible steroid interactions with the host immune-response to the virus have not been demonstrated in short-term administration. Our case suggests focusing on this last topic. <p></p> | ||
| 700 | 1 | |a Iannone, Andrea |e verfasserin |4 aut | |
| 700 | 1 | |a Giangaspero, Antonio |e verfasserin |4 aut | |
| 700 | 1 | |a Castellaneta, Nicola Maurizio |e verfasserin |4 aut | |
| 700 | 1 | |a Losurdo, Giuseppe |e verfasserin |4 aut | |
| 700 | 1 | |a Principi, Mariabeatrice |e verfasserin |4 aut | |
| 700 | 1 | |a Barone, Michele |e verfasserin |4 aut | |
| 700 | 1 | |a Ierardi, Enzo |e verfasserin |4 aut | |
| 700 | 1 | |a Leo, Alfredo Di |e verfasserin |4 aut | |
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