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

Author(s): Endrit Shahini, Andrea Iannone, Antonio Giangaspero, Nicola Maurizio Castellaneta, Giuseppe Losurdo, Mariabeatrice Principi, Michele Barone, Enzo Ierardi*, Alfredo Di Leo.

Journal Name: Anti-Infective Agents

Volume 15 , Issue 1 , 2017

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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.

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Article Details

VOLUME: 15
ISSUE: 1
Year: 2017
Page: [15 - 19]
Pages: 5
DOI: 10.2174/2211352514666160923161105
Price: $58

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