Drug-induced Liver Injury with HHV-6 Reactivation

Abstract

Liver dysfunction was identified in a 16-year-old boy hospitalized with high fever and abdominal pain and fullness. He had received pharmacotherapy for a headache 2 months previously and other drugs for a high fever 4 days prior to being admitted to our hospital. The patient's liver dysfunction was consistent with and fulfilled the criteria for drug induced liver injury, but the laboratory findings showed elevated procalcitonin levels, hyponatremia and leukocytosis. Moreover, we confirmed the presence of human herpesvirus 6 (HHV-6) DNA. The patient exhibited symptoms of high fever and abdominal pain and fullness but no exanthema. The clinical and laboratory findings did not satisfy the criteria for drug-induced hypersensitivity syndrome, and we speculate that the diversity of clinical and laboratory findings may have resulted from HHV-6 reactivation. To the best of our knowledge, this is the first case report on drug-induced liver injury with various findings due to HHV-6 reactivation. HHV-6 reactivation should be considered in patients with drug induced liver injury even in the absence of exanthema.

Reactivation of Human Herpesvirus (HHV) 6 as Etiology of Acute Liver Injury in Drug Reaction With Eosinophilia and Systemic Symptoms (DRESS) syndrome: A Case Report

“…In DRESS, the most commonly affected organ apart from the skin is the liver [3,16,17] Though liver histology is well-reported for DRESS, this is the first report, to our knowledge, to suggest HHV-6 reactivation within the liver parenchyma itself [1,3,[17][18][19][20]. However, unlike the histologic patterns reported for HHV-6 reactivation among liver transplant patients, we observed centrilobular necrosis and normal portal tracts, bile ducts, and vessels.…”

“…However, unlike the histologic patterns reported for HHV-6 reactivation among liver transplant patients, we observed centrilobular necrosis and normal portal tracts, bile ducts, and vessels. Fujita et al similarly reported bridging perivenular necrosis and infiltration of the lymphocytes and eosinophils [ 18 ]. A series of liver biopsies (n=7) performed by Ichai et al in the setting of liver injury during DRESS found that all cases had intralobular necrosis, most commonly centrilobular necrosis (n=3), and lymphocytic infiltrate.…”

HHV‐6 in liver transplantation: A literature review

“…HHV‐6 is often reactivated from latency during periods of intense immunosuppression, although sporadic cases of HHV‐6 reactivation have been reported even in the immunocompetent . HHV‐6A & B are increasingly recognized as pathogens that can cause primary infection or reactivate from latency in liver transplant recipients, resulting in a variety of adverse clinical syndromes including fever, hepatitis and encephalitis, as well as higher rates of HCV progression and CMV reactivation, graft failure and mortality.…”