Navigation Links
Varicella zoster infection causes severe autoimmune hepatitis

Autoimmune hepatitis (AIH) is a chronic liver inflammation of unknown etiology that is characterized by the presence of circulatory autoantibodies and ongoing liver tissue damage. In the past few years, the understanding of this disease has grown, and it is believed that, in a genetically predisposed individual, certain agents such as drugs and viruses can trigger this process of self-induced liver damage.

Dr. Waleed K Al-Hamoudi from Saudi Arabia presented a case of severe AIH following varicella zoster infection in a 23-year-old man. This will be published on February 28, 2009 in the World Journal of Gastroenterology.

A 23-year-old man was referred to their hepatology service on September 1, 2007 with jaundice, anorexia, weight loss and malaise of 2 mo duration. The episode of jaundice was preceded by varicella zoster virus (VZV) infection (chicken pox), which he contracted from close contact with infected family members. Despite recovery from the skin eruption, he had persistent anorexia and intermittent right upper quadrant pain. One month later he developed increasing jaundice. His physical examination revealed jaundice and hepatomegaly 2 cm below the costal margin. His initial laboratory findings were as follows: hemoglobin 149 g/L, white blood cell count 9.9 109/L, platelets 512 109/L, erythrocyte sedimentation rate 39 mm/h, alanine aminotransferase (ALT) 1066 U/L, aspartate aminotransferase (AST) 755 U/L, alkaline phosphatase (ALP) 185 U/L, total bilirubin 425 μmol/L, direct bilirubin 318 μmol/L, and albumin 32 g/L. His globulins were elevated at 46 g/L and his IgG was also elevated at 20.5 g/L. The coagulation profile was normal. Anti-nuclear, anti-smooth muscle, anti-mitochondrial and antiliver/kidney microsomes (ALKM-1) autoantibodies were negative. Perinuclear antineutrophil cytoplasmic antibodies were positive. Hepatitis B surface antigen, anti-hepatitis B core antigen IgM, anti-hepatitis C virus antibodies, anticytomegalovirus (CMV) IgM, anti-Epstein-Barr virus (EBV) IgM, and anti-hepatitis A virus (HAV) IgM were all negative. Anti-VZV IgG antibodies were positive. Ceruloplasmin and iron indices were normal.

The patient refused a liver biopsy, therefore, they started him on a tapering course of prednisone for presumed AIH, at a starting dose of 60 mg. He responded to that dramatically, as he became totally asymptomatic and started gaining weight. Within 2 mo of treatment, his liver enzymes normalized. On tapering his steroids below 10 mg, his liver enzymes increased again. His prednisone dose was increased to 30 mg and 50 mg azathioprine was added, however, because of vomiting and epigastric pain, the latter was changed to mycophenolate mofetil 500 mg twice daily. Follow-up showed improvement in his liver enzymes. In August, 2008, he stopped all his medications as he was feeling well and his liver enzymes were normal.

In conclusion, VZV infection can trigger AIH that may progress to advance liver fibrosis and eventually cirrhosis in genetically predisposed individuals. Therefore, AIH should be considered in any patient with persistently altered liver enzymes following a viral infection. Similarly, patients with AIH should be screened for viral hepatitis.


Contact: Lai-Fu Li
World Journal of Gastroenterology

Related medicine news :

1. Largest Study to Date Compares Cholesterol Treatment in HIV Patients & Patients Without HIV Infection
2. CMV Infection in Solid Organ Transplantation: Clinical Clues and Prevention Strategies
3. Arbor Pharmaceuticals Announces the Launch of XYLAREX(TM) - A New Nonantibiotic Product for the Dietary Management of Recurrent Ear Infections in Children
4. Influenza Infection Costs Employers Billions Each Year; Working Adults Largest Group Not Immunized Annually
5. Johns Hopkins safety team works to eliminate bloodstream infections in the nation and the world
6. Influenza Infection Costs Employees Billions Each Year; Working Adults Largest Group Not Immunized Annually
7. Employers Support Non-Payment for Hospital-Acquired Infections
8. Alternative Surface Disinfection Explored in Latest Issue of American Journal of Infection Control (AJIC)
9. Finding May Lead to New Drugs for Urinary Infections
10. Infection prevention falls short in Canadian long-term care facilities
11. OHSU vaccine research targets HIV in the slower, early stage of infection
Post Your Comments:
(Date:11/29/2015)... San Jose, CA (PRWEB) , ... November 29, 2015 , ... ... Bay Area, is proud to announce their December, 2015, featured apartment community: Epic. In ... looking for corporate housing in the tight Bay Area rental market to efficiently find ...
(Date:11/28/2015)... , ... November 28, 2015 , ... Trying to relax ... created the COUCH BUDDY. "I conceived of this design due to personal experience with ... couch users. It promotes relaxation and convenience, as well as increases support. It also ...
(Date:11/27/2015)... , ... November 28, 2015 , ... There is only ... outperform our billings from last year? , This question has not been an easy ... coming to the retirement age and the younger workforce don’t share the same discipline ...
(Date:11/27/2015)... ... November 27, 2015 , ... According to an article ... way that they are handling security in light of the recent terrorist attacks in ... an attempt to stop an attack from reaching U.S. soil. Especially around special events ...
(Date:11/27/2015)... ... November 27, 2015 , ... An inventor, from ... dispense prescription medications at home, so he invented the patent-pending ELECTRONIC M.D. , ... prescription medications. In doing so, it could help to prevent potential overdose situations. ...
Breaking Medicine News(10 mins):
(Date:11/27/2015)... 27, 2015 --> ... go online. The potential to save costs, improve treatment ... far from fully exploited as yet. Here, particular emphasis ... either via mobile tablet or directly at the patients, ... ) -->      (Photo: ...
(Date:11/26/2015)... India , November 27, ... --> --> ... personal emergency response system (PERS) ... steadily for 5 years with ... region expected to see a ...
(Date:11/26/2015)... November 26, 2015 --> ... use SyMRI to find optimal contrast weighting of MRI ... and has signed a research agreement with SyntheticMR in order ... Using SyMRI, it is possible to generate multiple contrast images ... the patient has left, thus making it possible to both ...
Breaking Medicine Technology: