1192. Fulminant Adenovirus Hepatitis
Session: Poster Abstract Session: Non-CMV Viruses and Transplantation
Saturday, October 22, 2011
Room: Poster Hall B1

Background:  Fulminant hepatitis is an uncommon manifestation of Adenovirus infection, often limited to immunocompromised hosts.  A 70-year-old female with chronic lymphocytic leukemia (CLL) on rituximab and fludarabine therapy was hospitalized with persistent fever.  She developed fulminant hepatic failure, and liver biopsy confirmed necrotizing hepatitis due to Adenovirus.

Methods:  A review of the English-language literature for definite cases of Adenovirus hepatitis (AH) was performed.

Results:  88 cases of AH have been reviewed.  Forty-three (49%) were liver transplant recipients, 18 (20%) were bone marrow transplant recipients, 11 (13%) had received chemotherapy, 5 (6%) had severe combined immunodeficiency, 4 (4%) were infected with the human immunodeficiency virus, 2 had heart transplants, 2 had kidney transplants, 2 were neonates, and 1 had CLL alone.  About half occurred in the first month after transplant (bone marrow or solid organ), most before 6 months post-transplant.  Fever was the initial symptom in 92%.  Liver function tests were elevated anywhere from 1 to 110 times the upper limit of normal.  Abdominal computed tomography showed hypodense lesions in 7 of 8 cases, and ultrasound was normal in 6 of 8 cases.  Diagnosis was made by liver biopsy in 43 (49%), and on autopsy in 45 (51%).  Necrosis was the most common histologic finding, followed by viral inclusions and smudge cells.  Serotypes 5 and 2 were the most frequently isolated.  Adenovirus was isolated at other sites in 54 cases (50% in lung or bronchoalveolar lavage samples, 43% in the urinary tract, 33% in the gastrointestinal tract and 22% in throat culture).  Only 21 of 88 patients (24%) survived: 13 whose immunosuppression was reduced, 6 with liver re-transplantation, and 2 who received cidofovir and intravenous immunoglobulin. 

Conclusion:  AH occurs predominantly in immunocompromised hosts, and manifests as fulminant necrotizing hepatitis.  Diagnosis requires liver biopsy with in situ hybridization, culture, electron microscopy, or PCR testing for Adenovirus.  Early consideration of a viral etiology for fulminant hepatitis, reduced immunosuppression and liver transplantation may be potentially life-saving.  A concurrent trial of cidofovir should be considered. 

 


Subject Category: O. Transplant infectious diseases

Bridgett A. Ronan, MD1, Holenarasipur Vikram, MD, FACP2, Neera Agrwal, MD1, Elizabeth Carey, MD3, Giovanni DePetris, MD4, Shimon Kusne, MD2, Maria Teresa Seville, MD2 and Janis Blair, MD2, (1)Division of Internal Medicine Mayo Clinic Hospital, Phoenix, AZ, (2)Division of Infectious Diseases Mayo Clinic Hospital, Phoenix, AZ, (3)Division of Hepatology Mayo Clinic Hospital, Phoenix, AZ, (4)Division of Pathology Mayo Clinic Hospital, Phoenix, AZ

Disclosures:

B. A. Ronan, None

H. Vikram, None

N. Agrwal, None

E. Carey, None

G. DePetris, None

S. Kusne, None

M. T. Seville, None

J. Blair, None

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