title: Histopathologic resolution of adult liver transplantation adenovirus hepatitis with cidofovir and intravenous immunoglobulin: a case report.
abstract: Adenovirus (ADV) infections in adult solid organ transplant recipients, although rare, are associated with high mortality. There are no randomized controlled trials establishing the efficacy of specific treatment modalities. To our knowledge apparent response to treatment with combination therapy with intravenous cidofovir (CDV) and immunoglobulin (IVIG) has only been demonstrated in 2 adult renal transplant recipients in whom ADV was documented in body fluids only. We describe an adult liver transplant recipient diagnosed with ADV hepatitis based on positive immunohistochemical staining of a liver biopsy specimen, positive blood ADV DNA polymerase chain reaction (PCR), and treated with the combination of CDV and IVIG. We demonstrated both clearance of viremia and histopathologic resolution of the hepatitis despite the patient's fatal outcome. To our knowledge this is the only case documenting eradication of tissue-invasive ADV disease in any solid organ transplant recipient using CDV and IVIG. This case provides evidence to support the use of this drug combination, which has many potential toxicities that might discourage its use otherwise.
authors.affiliation: Department of Medicine, University of Florida College of Medicine, Gainesville, Florida 32610-0277, USA.
authors.forename: T
authors.initials: T
authors.lastname: Kerensky
authors.forename: A
authors.initials: A
authors.lastname: Hasan
authors.forename: D
authors.initials: D
authors.lastname: Schain
authors.forename: G
authors.initials: G
authors.lastname: Trikha
authors.forename: C
authors.initials: C
authors.lastname: Liu
authors.forename: K
authors.initials: K
authors.lastname: Rand
authors.forename: C
authors.initials: C
authors.lastname: Soldevila-Pico
authors.forename: A
authors.initials: A
authors.lastname: Gupte
mesh_terms: D000257:Adenoviridae Infections / Q000188:drug therapy* / Q000601:surgery; D000998:Antiviral Agents / Q000008:administration & dosage; D000077404:Cidofovir; D003596:Cytosine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D017809:Fatal Outcome; D006505:Hepatitis / Q000188:drug therapy* / Q000601:surgery / Q000821:virology; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage*; D007155:Immunologic Factors / Q000008:administration & dosage; D008099:Liver / Q000473:pathology*; D008108:Liver Diseases, Alcoholic / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D063065:Organophosphonates / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D063065:Organophosphonates; D003596:Cytosine; D000077404:Cidofovir