title: Fulminant hepatitis due to human adenovirus.
abstract: OBJECTIVE
  To describe the demographics, clinical manifestations, treatment and outcomes of patients with human adenovirus (HAdV) hepatitis.
  
  
  METHODS
  A case of fulminant HAdV hepatitis in a patient with chronic lymphocytic leukemia receiving rituximab and fludarabine is described. We conducted a comprehensive review of the English-language literature through May, 2012 in search of definite cases of HAdV hepatitis.
  
  
  RESULTS
  Eighty-nine cases were reviewed. Forty-three (48 %) were liver transplant recipients, 19 (21 %) were bone marrow transplant recipients, 11 (12 %) had received chemotherapy, five (6 %) had severe combined immunodeficiency, four (4 %) were HIV infected, two had heart transplantation, and two were kidney transplant recipients. Ninety percent (46/51) of patients presented within 6 months following transplantation. Fever was the most common initial symptom. Abdominal CT scan revealed hypodense lesions in eight of nine patients. Diagnosis was made by liver biopsy in 43 (48 %), and on autopsy in 46 (52 %). The HAdV was isolated at other sites in 54 cases. Only 24 of 89 patients (27 %) survived: 16 whose immunosuppression was reduced, six with liver re-transplantation, and two who received cidofovir and intravenous immunoglobulin.
  
  
  CONCLUSIONS
  HAdV hepatitis can manifest as a fulminant illness in immunocompromised hosts. Definitive diagnosis requires liver biopsy. Early consideration of a viral etiology, reduction in immunosuppression, and liver transplantation can be potentially life-saving.
authors: Division of Pulmonary Medicine, Mayo Clinic, Phoenix, AZ, USA.
authors: B A
authors: BA
authors: Ronan
authors: N
authors: N
authors: Agrwal
authors: E J
authors: EJ
authors: Carey
authors: G
authors: G
authors: De Petris
authors: S
authors: S
authors: Kusne
authors: M T
authors: MT
authors: Seville
authors: J E
authors: JE
authors: Blair
authors: H R
authors: HR
authors: Vikram
mesh_terms: D000258:Adenovirus Infections, Human / Q000175:diagnosis* / Q000473:pathology* / Q000821:virology; D000260:Adenoviruses, Human / Q000302:isolation & purification*; D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage; D001706:Biopsy; D005260:Female; D006525:Hepatitis, Viral, Human / Q000175:diagnosis* / Q000473:pathology* / Q000821:virology; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000150:complications / Q000188:drug therapy; D008099:Liver / Q000473:pathology; D000069283:Rituximab; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D007166:Immunosuppressive Agents; D000069283:Rituximab; D014740:Vidarabine; C024352:fludarabine
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