Epstein-Barr virus (EBV) related acute liver failure: a case series from the US Acute Liver Failure Study Group.
OBJECTIVE
Acute liver failure (ALF) is a rare clinical syndrome associated with a high case fatality rate. Asymptomatic primary infection with Epstein-Barr virus (EBV) is common in the general population while acute hepatitis and jaundice are much less common and ALF has been rarely reported. We reviewed the presenting features as well as clinical outcomes amongst consecutive adults with EBV-related ALF.


METHODS
Amongst the 1,887 adult ALF patients enrolled into the US ALF Study Group from January 1998 to February 2012, there were four patients (0.21 %) with EBV-related ALF. Diagnostic criteria for acute EBV infection included compatible serologies and/or the detection of EBV-encoded RNA (EBER) in liver tissue.


RESULTS
Median patient age was 30 years (range 18-44); 75 % were male, and only 25 % were immunosuppressed. The median presenting ALT was 504 IU/mL (range 156-4,920), median Alk P was 431 (range 136-1,009), and median bilirubin was 17 mg/dL (range 13-22.1). Liver biopsy findings ranged from cholestasis to submassive necrosis with EBER + staining in two of the three samples tested. Although all of the patients were treated with an antiviral agent, two died of ALF, one underwent liver transplantation (LT) and one survived with supportive care and is well at 5 years. A review of the literature identified four additional LT recipients with favorable long-term outcomes.


CONCLUSIONS
Primary EBV infection accounts for <1 % of consecutive adult ALF cases but is associated with a high case fatality rate. LT is associated with favorable short- and long-term outcomes.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan Health System, 3912 Taubman Center, 1500 E. Medical Center Drive, SPC 5362, Ann Arbor, MI, 48109-0362, USA.
Jessica L
JL
Mellinger
Lorenzo
L
Rossaro
Willscott E
WE
Naugler
Satish N
SN
Nadig
Henry
H
Appelman
William M
WM
Lee
Robert J
RJ
Fontana
D000293:Adolescent; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D020031:Epstein-Barr Virus Infections / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D005260:Female; D006801:Humans; D017114:Liver Failure, Acute / Q000401:mortality / Q000601:surgery / Q000821:virology*; D016031:Liver Transplantation; D008297:Male; D011446:Prospective Studies; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
D000998:Antiviral Agents