Immunohistologic identification of Epstein-Barr virus-induced hepatitis reactivation after OKT-3 therapy following orthotopic liver transplant.
Reactivated Epstein-Barr virus infection associated with hepatitis appeared in a liver transplant patient receiving monoclonal OKT-3 antibody for rejection. The histologic findings in liver biopsy specimens characteristic of allograft rejection were observed prior to and during the initial phase of antirejection therapy. However, failure of a complete response to antirejection therapy promoted rebiopsy. The specimen showed portal infiltrates composed predominantly of plasma cells and immunoblasts. The presumptive diagnosis of Epstein-Barr virus hepatitis was confirmed by staining frozen liver tissue for Epstein-Barr virus nuclear-associated antigen. OKT-3 therapy was discontinued, and cyclosporine and steroid doses were reduced. Gradually, clinical features, serum aminotransferase and bilirubin levels, and the portal lymphoid infiltrate resolved. Epstein-Barr virus serology showed an increase in convalescent titers IgG-antiviral capsid antigen, and Epstein-Barr virus nuclear-associated antigen. The histologic, clinical, and laboratory features supporting the diagnosis of Epstein-Barr virus hepatitis in a liver transplant patient are presented and discussed. This diagnosis guided appropriate therapy.
Markin
R S
RS
Department of Pathology, Eppley Institute for Research in Cancer and Allied Diseases, University of Nebraska Medical Center, Omaha.
Wood
R P
RP
Shaw
B W
BW
Brichacek
B
B
Purtilo
D T
DT
D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D001706:Biopsy; D003524:Cyclosporins / Q000627:therapeutic use; D005260:Female; D006084:Graft Rejection; D006525:Hepatitis, Viral, Human / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D004854:Herpesvirus 4, Human / Q000254:growth & development / Q000302:isolation & purification*; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use; D012008:Recurrence; D014775:Virus Activation
D000911:Antibodies, Monoclonal; D003524:Cyclosporins; D011241:Prednisone