title: Severe viral hepatitis in a patient with chronic lymphocytic leukemia (CLL) complicated with autoimmune hemolytic anemia (AIHA), treated with steroids.
abstract: Infectious complications are a major cause of morbidity and mortality in patients with chronic lymphocytic leukemia (CLL) due to impaired immunity secondary to the disease itself and to the immunosuppressive therapies administered to these patients. We report a 78-year-old woman with CLL who was treated with steroids for autoimmune hemolytic anemia (AIHA). A few weeks later, she was admitted for severe acute hepatitis with disseminated intravascular coagulation (DIC). Despite the symptomatic treatment of DIC, standard reanimation and probabilistic antibiotics, the patient died within 24h with severe hepatic failure. Autopsy was in favor of a disseminated viral infection with esophageal, hepatic and pulmonary cytopathologic lesions with acidophilic intranuclear inclusions suggestive of herpes virus, even though HSV 1 and 2, CMV and HHV6 PCRs were negative. This case of severe viral hepatitis with esophagitis occurring three weeks after the introduction of high-dose steroid treatment for AIHA in a CLL patient calls for anti-herpetic prophylaxis in such patients, immunodepressed by their diseases and the treatment they receive.
authors.affiliation: CHU Angers, Service des Maladies du Sang, Angers, France.
authors.forename: Corentin
authors.initials: C
authors.lastname: Orvain
authors.affiliation: CHU Angers, Laboratoire de virologie, Angers, France.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Ducancelle
authors.affiliation: CHU Angers, Département de pathologie cellulaire et tissulaire, Angers, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Eymerit-Morin
authors.affiliation: CHU Angers, Département de pathologie cellulaire et tissulaire, Angers, France.
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Rousselet
authors.affiliation: CHU Angers, Service d'hépato-gastroentérologie, Angers, France.
authors.forename: Frederic
authors.initials: F
authors.lastname: Oberti
authors.affiliation: CHU Angers, Service des Maladies du Sang, Angers, France; INSERM U892, France.
authors.forename: Mathilde
authors.initials: M
authors.lastname: Hunault-Berger
authors.affiliation: CHU Angers, Service des Maladies du Sang, Angers, France; INSERM U892, France. Electronic address: alschmidt@chu-angers.fr.
authors.forename: Aline
authors.initials: A
authors.lastname: Tanguy-Schmidt
mesh_terms: D000368:Aged; D000744:Anemia, Hemolytic, Autoimmune / Q000150:complications* / Q000188:drug therapy; D001706:Biopsy; D017809:Fatal Outcome; D005260:Female; D006525:Hepatitis, Viral, Human / Q000175:diagnosis* / Q000209:etiology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000150:complications* / Q000188:drug therapy; D008099:Liver / Q000473:pathology / Q000821:virology; D013256:Steroids / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D007166:Immunosuppressive Agents; D013256:Steroids
keywords: Autoimmune hemolytic anemia (AIHA); Chronic lymphocytic leukemia (CLL); Viral hepatitis