Herpes Simplex Virus Hepatitis after Solid Organ Transplantation in Adults

Kusne, Shimon; Schwartz, Michelle; Breinig, Mary Kay; Dummer, J. Stephen; Lee, R E; Selby, Richard W.; Starzl, Thomas E.; Simmons, Richard L.; Ho, Monto

doi:10.1093/infdis/163.5.1001

Cited by 151 publications

(80 citation statements)

References 32 publications

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“…The main dissimilarity is that all three patients with varicella hepatitis had skin lesions. In our report of herpes simplex hepatitis, skin lesions were not common, even in cases with autopsy-proven disseminated disease to multiple organs (16). This is similar to bone marrow Tx, where higher rates of VZV visceral dissemination without skin manifestations have been reported (17).…”

Section: Casesupporting

confidence: 81%

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Varicella-Zoster Virus Hepatitis and a Suggested Management Plan for Prevention of VZV Infection in Adult Liver Transplant Recipients

et al. 1995

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Infection with varicella-zoster virus (VZV) is common, occurring as primary varicella, usually during childhood, and as zoster, following reactivation of latent virus. Although serious VZV infections are infrequent, they can be life-threatening when they occur in susceptible immunosuppressed patients (1, 2). These patients have a high incidence of visceral involvement, including pneumonitis, meningoencephalitis, and rarely, hepatitis. We report here 3 cases of VZV hepatitis in adult liver transplant recipients that occurred in our institution between 1984 and 1989. We describe their clinical presentations and use these cases to illustrate some aspects in diagnosis and prevention of VZV infection after solid organ Tx. Case 1A 19-year-old woman underwent orthotopic liver Tx for end-stage liver disease secondary to chronic active autoimmune hepatitis. She was receiving prednisone and azathioprine before the transplant operation. Her immunosuppression after Tx included cyclosporine (CSA) and steroids. At 28 days after her transplant operation, she started complaining of low back pain over the coccyx area, but the exam of this area did not reveal any skin lesions. Two days later she developed few skin vesicles on her face, abdomen, and hands. Laboratory examination showed elevation in LFTs with serum alanine aminotrahsferase (ALT) of 196 lU/L (normal value [nv] <40, lU/L), serum aspartate aminotransferase (AST) of 221 IU/L (nv <40 IU/L) and bilirubin of 3.5 mg% (nv <1.0 mg/dl), and gamma GTP of 137 (nv <40 U/L). On day 33 after OLTx, her AST increased to 1057 lU/L and bilirubin increased to 4.7 mg/dl. Liver biopsy showed foci of coagulative necrosis with minimal mixed inflammatory cellular infiltrate and multinucleated cells, with negative histochemical stains for HSV 1 and HSV 2. The patient was started the same day on intravenous acyclovir at 10 mg/kg every 8 hr, but the following day she developed DIC and ARDS and expired 37 days after Tx. A blood buffy coat specimen was positive subsequently for VZV by culture. IgG antibody for VZV was negative on day 33 after OLTx by indirect fluorescence assay (IFA). No history of exposure to VZV was obtained. Case 2A 33-year-old man underwent a liver and pancreas Tx for end-stage liver disease secondary to hepatitis B infection and hepatoma. Immunosuppression treatment included CSA and steroids. His spleen and pancreas and part of his colon, duodenum, and stomach were also Fig. 1) and nuclear inclusions were seen (Fig. 2), but histochemical stains were negative for HSV 1 and HSV 2. The patient's skin examination revealed vesicular lesions on the palmar aspect of his hands and also on his neck. He was placed on i.v. acyclovir at 10 mg/kg after each dialysis, and was also given a dose of VZIG. Buffy coat and vesicular skin lesions samples yielded VZV.He remained on a respirator, required hemodialysis, and developed bacterial and fungal abdominal sepsis secondary to leaks from the bowel. At 31 days after retransplantation he required distal pancreatectomy for pancreatic phlegmon...

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Section: Casesupporting

confidence: 81%

“…We have previously reported 12 patients who developed herpes simplex hepatitis after solid organ Tx (16). Five of these patients developed disseminated intravascular coagulation and expired.…”

Section: Casementioning

confidence: 99%

Varicella-Zoster Virus Hepatitis and a Suggested Management Plan for Prevention of VZV Infection in Adult Liver Transplant Recipients

et al. 1995

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“…Although HSV hepatitis is a rare clinical manifestation of HSV infection, usually associated with impaired immunity such as during organ transplant, it has a high mortality. 63,64 This strategy of targeting viral growth and spread to specific tumor cell types, in a non-virulent virus backbone provides new opportunities for tumor therapy.…”

mentioning

confidence: 99%

Hepatoma-specific antitumor activity of an albumin enhancer/promoter regulated herpes simplex virus in vivo

Tani

Feigenbaum

et al. 1999

Gene Ther

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Targeting viral vectors to appropriate cell types so that norexpressing tumor cell lines, while all cell lines were equally mal cells are not adversely affected is an important goal susceptible to a tissue nonspecific HSV recombinant, hrR3. for gene therapy. Previously, we described a novelIn vivo, G92A replicated well in subcutaneous xenografts approach to viral gene therapy using a conditional, repliof human hepatoma cells (Hep3B) in athymic mice, but not cation-competent herpes simplex virus (HSV), where repliin non-hepatoma subcutaneous tumors (PC3 and HeLa), cation and associated cytotoxicity are limited to a specific whereas, hrR3 replicated well in both tumor types. Intratucell-type by the regulated expression of an essential moral inoculation of G92A inhibited the growth of estabimmediate-early viral gene product. In this report we analished subcutaneous hepatoma tumors in nude mice, but lyze the hepatoma-specific replication, cytotoxicity and not prostate tumors. Replication-competent viral vectors anti-tumor effect of recombinant HSV G92A, regulated by controlled by cell-specific transcriptional regulatory the albumin enhancer/promoter. G92A efficiently replicated sequences provide a new therapeutic strategy for tumor in vitro in two human hepatoma cell lines expressing albutherapy. min, but not in four human non-hepatoma, albumin-non-

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“…Lesions (13,14). Fever, leucopenia and hepatitis are common presenting signs of disseminated disease.…”

Section: A Minority Of Immunocompetent Persons Infected With Hsv Devementioning

confidence: 99%

Herpes Simplex Virus Infections in Solid Organ Transplant Recipients

Zuckerman

Wald

2009

American Journal of Transplantation

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Herpes Simplex Virus Hepatitis after Solid Organ Transplantation in Adults

Cited by 151 publications

References 32 publications

Varicella-Zoster Virus Hepatitis and a Suggested Management Plan for Prevention of VZV Infection in Adult Liver Transplant Recipients

Varicella-Zoster Virus Hepatitis and a Suggested Management Plan for Prevention of VZV Infection in Adult Liver Transplant Recipients

Hepatoma-specific antitumor activity of an albumin enhancer/promoter regulated herpes simplex virus in vivo

Herpes Simplex Virus Infections in Solid Organ Transplant Recipients

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