Fulminant Adenoviral-Induced Hepatitis in Immunosuppressed Patients

Abstract

Human adenovirus (HAdV) can often lead to fulminant hepatitis in immunocompromised patients, mostly after reactivation of HAdV. Different risk factors, e.g., transplantation and chemotherapy, increase the risk of developing a HAdV hepatitis. We retrospectively analyzed three patients who showed the characteristics of a HAdV hepatitis observed in disseminated disease. In addition to PCR, diagnosis could be proven by pathology, CT scan, and markedly elevated transaminases. All patients had a hemato-oncologic underlying disease. Two had received a stem-cell transplant, and one was under chemotherapy including rituximab. Despite therapy with cidofovir, all patients died. As the incidence of HAdV hepatitis is low, diagnosis may be easily overlooked. No treatment approaches have yet been established. HAdV hepatitis should be considered as a differential diagnosis, especially when risk factors are present. To avoid dissemination, treatment should be initiated as soon as possible.

Adeno-associated virus type 2 in US children with acute severe hepatitis

“…HAdVs are non-enveloped, double-stranded DNA viruses that cause a variety of infections in both adults and children, including respiratory tract infection, conjunctivitis and gastroenteritis (mainly from HAdV type 40 (HAdV-40) and HAdV-41) 9 . Although a potentially life-threatening disease in immunocompromised patients 7 , 9 , hepatitis from adenovirus infection has been thought to be rare in immunocompetent children without underlying comorbidities 10 . HAdVs, particularly HAdV-41, have been found in blood from clusters of acute severe hepatitis cases from Scotland, the UK and the USA 3 – 7 , but whether the virus is causative remains unclear.…”

(Seltene) infektiöse Hepatitiden als wichtige Differenzialdiagnose der unklaren Hepatopathie

“…Sehr typisch waren hierbei die diffus verteilten, fleckartigen Nekrosen, die auf keine Leberzone beschränkt waren, sowie als wichtiger Hinweis auf eine virale Genese die typischen intranukleären Einschlüsse. Der detaillierte klinische Verlauf beider Fälle wurde bereits in einer anderen Vorarbeit aufgearbeitet [ 11 ]. Differenzialdiagnostisch sollten andere infektiöse Genese wie eine Infektion durch Herpes simplex ausgeschlossen sein (z.…”

Lipid nanoparticle-encapsulated, chemically modified anti-adenoviral siRNAs inhibit hepatic adenovirus infection in immunosuppressed Syrian hamsters

“… 15 However, only a small majority of patients profits from the treatment. 16 , 17 , 18 Moreover, CDV is nephrotoxic, 19 and gastrointestinal toxicity upon oral application in a phase III clinical trial 20 was observed after treatment of patients with BCV. Another promising therapy for these infections is hAd-specific T cell therapy, 21 but because of its personalized nature, this therapy is costly and time consuming, limiting its application in patients.…”