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Hepatitis associated with systemic viral infections

For a detailed description of these diseases, reference is made to infectious diseases textbooks.

Epstein-Barr Virus (Infectious mononucleosis)

Up to 90% of patients experience a 2–3 fold increase in transaminases and mild hyperbilirubinemia, which subside within 4 weeks. Fulminant hepatitis or haemophagocytosis syndrome (fever, hepatosplenomegaly, liver failure, cytopenia and severe hyperferritinemia) with fatal outcome are rarely described. The diagnosis is made by detection of anti-EBV IgM or in a liver biopsy showing a mononuclear infiltrate, in situ Hybridization and PCR. A specific therapy has not been established; in individual case reports, an improvement was achieved with ganciclovir.

Cytomegalovirus (CMV)

The initial infection causes a mononucleosis-like disease in immunocompetent persons, which is often associated with a mild increase in transaminases and alkaline phosphatase, but only very rarely causes granulomatous, cholestatic hepatitis up to massive hepatocellular necrosis with fatal outcome. Disseminated CMV infection with hepatitis, pancreatitis, acalculous gangrenous cholecystitis, or PSC-like cholangiopathy can occur in people infected with HIV. In liver transplant recipients, initial infection or CMV reactivation can lead to aggressive hepatitis (without cholangiopathy). The diagnosis is made by detection of CMV-IgM or a positive CMV-PCR and occasionally histologically, among other things. with the typical representation of owl-like cell inclusions. In the case of immunocompetent the therapy is symptomatic, in the case of immunosuppressed ganciclovir, or as second-line therapy, foscarnet or cidofovir are used.

Herpes simplex virus

Infected newborns during the birth process can suffer from severe multi-organ infestation with hepatitis and adrenal insufficiency. Even in pregnant women, the infection is usually fulminant and is often diagnosed too late because 50% of the cases are missing skin lesions. In both situations the mortality rate is close to 40%. In other immunocompetent adults, genital herpes infection only occasionally leads to a slight increase in transaminases, while immunosuppressed individuals can also show fulminant courses. The diagnosis is made histologically. The liver biopsy shows here Frosted glass hepatocytes with intranuclear inclusion bodies and hemorrhagic necrosis. PCR and immunohistochemistry are used for more specific confirmation of the diagnosis. Treatment with acyclovir must be started immediately if there is clinical suspicion.

Yellow fever virus

It is transmitted by mosquitoes in tropical and subtropical regions of Africa and South America. For a few days there is usually self-limiting nausea and fever. Hepatitis with jaundice and coagulation disorder (hemorrhagic fever) occurs rarely. A live vaccine is available.

More viral hepatitis

The following viral infections can occasionally be associated with hepatic involvement: Varicella zoster virus, coronavirus with SARS, Coxsackie, Dengue, Lassa, Marburg, and Ebola virus, Rift Valley Fever, and South American Hemorrhagic Fever.