Article Details


Epstein-Barr Virus-Related Hyperacute Hepatitis: May Intravenous Steroids be an Effective Approach?

[ Vol. 15 , Issue. 1 ]

Author(s):

Endrit Shahini, Andrea Iannone, Antonio Giangaspero, Nicola Maurizio Castellaneta, Giuseppe Losurdo, Mariabeatrice Principi, Michele Barone, Enzo Ierardi and Alfredo Di Leo   Pages 15 - 19 ( 5 )

Abstract:


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.

Objective: We report the beneficial effect of steroid therapy in this clinical condition.

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”).

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.

Keywords:

Epstein-Barr virus, severe acute hepatitis, steroid therapy, viral clearance, liver failure, viral hepatitis.

Affiliation:

Department of Emergency and Organ Transplantation, Section of Gastroenterology, University of Bari, Bari, Department of Emergency and Organ Transplantation, Section of Gastroenterology, University of Bari, Bari, Department of Emergency and Organ Transplantation, Section of Gastroenterology, University of Bari, Bari, Department of Emergency and Organ Transplantation, Section of Gastroenterology, University of Bari, Bari, Department of Emergency and Organ Transplantation, Section of Gastroenterology, University of Bari, Bari, Department of Emergency and Organ Transplantation, Section of Gastroenterology, University of Bari, Bari, Department of Emergency and Organ Transplantation, Section of Gastroenterology, University of Bari, Bari, Department of Emergency and Organ Transplantation, Section of Gastroenterology, University of Bari, Bari, Department of Emergency and Organ Transplantation, Section of Gastroenterology, University of Bari, Bari

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