Hayashi M, Takeyama K, Takayama J, Ohira M, Tobinai K, Shimoyama M
Hematology-Oncology and Medical Oncology Division, National Cancer Center Hospital, Tokyo.
Jpn J Clin Oncol. 1991 Oct;21(5):372-6.
A 17-year-old male patient with T-cell type lymphoblastic lymphoma in complete remission underwent high dose chemotherapy (busulfan 16 mg/kg and cyclophosphamide 120 mg/kg) followed by autologous bone marrow transplantation (ABMT). The patient had been taking oral acyclovir (200 mg x 5) daily from seven days prior to the ABMT (day -7). On day +24, he complained of epigastralgia and general malaise, and the next day his GOT and GPT rose to 570 U/l and 397 U/l, respectively. Although he had no mucocutaneous lesions, hepatitis caused by a herpes virus was suspected, and high dose intravenous acyclovir (10 mg/kg x 3/day) was immediately started. His GOT, GPT and total bilirubin reached peaks of 2,870 U/l on day +26, 1,830 U/l on day +27 and 10.3 mg/dl on day +39, respectively, and rapidly improved thereafter. Serological analyses on IgG antibody titers to herpes simplex virus type 1 using an enzyme-linked immunosorbent assay revealed specific increases (454-fold before transplantation to 3,830-fold on day +46). Antiviral antibody titers to cytomegalovirus, varicella-zoster virus and Epstein-Barr virus showed no significant changes. The serologic markers of hepatitis B virus, hepatitis A virus and hepatitis C virus were all negative. The results indicate the patient's severe icteric hepatitis to have been caused by a reactivation of herpes simplex virus type 1 due to immunosuppression after high dose chemotherapy with ABMT. It is suggested that prompt commencement of high dose intravenous acyclovir is required to treat severe herpes simplex virus hepatitis affecting immunocompromised patients.
一名处于完全缓解期的17岁男性T细胞型淋巴细胞淋巴瘤患者接受了大剂量化疗（白消安16mg/kg和环磷酰胺120mg/kg），随后进行了自体骨髓移植（ABMT）。该患者自ABMT前7天（-7天）起每天口服阿昔洛韦（200mg×5）。在+24天，他主诉上腹部疼痛和全身不适，次日其谷草转氨酶（GOT）和谷丙转氨酶（GPT）分别升至570U/l和397U/l。尽管他没有皮肤黏膜损害，但怀疑是疱疹病毒引起的肝炎，立即开始静脉注射大剂量阿昔洛韦（10mg/kg×3/天）。他的GOT、GPT和总胆红素分别在+26天达到峰值2870U/l、+27天达到峰值1830U/l和+39天达到峰值10.3mg/dl，此后迅速改善。使用酶联免疫吸附测定法对1型单纯疱疹病毒的IgG抗体滴度进行的血清学分析显示有特异性升高（移植前为454倍，+46天为3830倍）。针对巨细胞病毒、水痘-带状疱疹病毒和EB病毒的抗病毒抗体滴度无显著变化。乙肝病毒、甲肝病毒和丙肝病毒的血清学标志物均为阴性。结果表明，该患者的严重黄疸型肝炎是由于大剂量化疗联合ABMT后免疫抑制导致1型单纯疱疹病毒重新激活所致。建议对于影响免疫功能低下患者的严重单纯疱疹病毒性肝炎，应迅速开始静脉注射大剂量阿昔洛韦进行治疗。
