Division of Pulmonary Medicine, Mayo Clinic, Phoenix, AZ, USA.
Infection. 2014 Feb;42(1):105-11. doi: 10.1007/s15010-013-0527-7. Epub 2013 Aug 24.
To describe the demographics, clinical manifestations, treatment and outcomes of patients with human adenovirus (HAdV) hepatitis.
A case of fulminant HAdV hepatitis in a patient with chronic lymphocytic leukemia receiving rituximab and fludarabine is described. We conducted a comprehensive review of the English-language literature through May, 2012 in search of definite cases of HAdV hepatitis.
Eighty-nine cases were reviewed. Forty-three (48 %) were liver transplant recipients, 19 (21 %) were bone marrow transplant recipients, 11 (12 %) had received chemotherapy, five (6 %) had severe combined immunodeficiency, four (4 %) were HIV infected, two had heart transplantation, and two were kidney transplant recipients. Ninety percent (46/51) of patients presented within 6 months following transplantation. Fever was the most common initial symptom. Abdominal CT scan revealed hypodense lesions in eight of nine patients. Diagnosis was made by liver biopsy in 43 (48 %), and on autopsy in 46 (52 %). The HAdV was isolated at other sites in 54 cases. Only 24 of 89 patients (27 %) survived: 16 whose immunosuppression was reduced, six with liver re-transplantation, and two who received cidofovir and intravenous immunoglobulin.
HAdV hepatitis can manifest as a fulminant illness in immunocompromised hosts. Definitive diagnosis requires liver biopsy. Early consideration of a viral etiology, reduction in immunosuppression, and liver transplantation can be potentially life-saving.
描述人类腺病毒（HAdV）肝炎患者的人口统计学、临床表现、治疗和结局。
描述了一例接受利妥昔单抗和氟达拉滨治疗的慢性淋巴细胞白血病患者发生暴发性 HAdV 肝炎的病例。我们通过全面检索截至 2012 年 5 月的英文文献，搜索明确的 HAdV 肝炎病例。
共回顾了 89 例病例。43 例（48%）为肝移植受者，19 例（21%）为骨髓移植受者，11 例（12%）接受过化疗，5 例（6%）患有严重联合免疫缺陷，4 例（4%）HIV 感染，2 例有心脏移植，2 例为肾移植受者。90%（46/51）的患者在移植后 6 个月内出现症状。发热是最常见的初始症状。9 例患者中有 8 例腹部 CT 扫描显示低密病灶。43 例（48%）通过肝活检诊断，46 例（52%）通过尸检诊断。54 例在其他部位分离出 HAdV。89 例患者中仅有 24 例（27%）存活：16 例减少免疫抑制，6 例肝再移植，2 例接受更昔洛韦和静脉注射免疫球蛋白。
HAdV 肝炎可在免疫功能低下宿主中表现为暴发性疾病。明确诊断需要肝活检。早期考虑病毒病因、减少免疫抑制和肝移植可能具有挽救生命的作用。
