Wang Ching-Hsun, Li Yao-Feng, Shen Chih-Hao
Department of Internal Medicine, Division of Infectious and Tropical Medicine, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan.
Department of Pathology, Division of Anatomic Pathology, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan.
Hepat Mon. 2014 Sep 17;14(9):e18865. doi: 10.5812/hepatmon.18865. eCollection 2014 Sep.
Although hepatitis is frequently observed during antituberculosis (anti-TB) therapy, acute viral hepatitis should be ruled out first, especially in the endemic areas. In addition to common types of viral hepatitis, ie, hepatitis A, hepatitis B, and hepatitis C viruses, Epstein-Barr virus (EBV) may result in hepatitis in some cases.
Herein, we reported a critically ill patient who developed cholestatic hepatitis in the intensive care unit during the anti-TB therapy, which was misdiagnosed as anti-TB agents-induced hepatitis in the beginning. Further serologic tests and liver biopsy confirmed the diagnosis of EBV hepatitis. In contrast to previously reported hepatitis by EBV, which had presented with transient liver dysfunction and self-limiting illness, hepatitis with progressive jaundice was followed by coagulopathy and encephalopathy in our case and the patient died of hepatic failure complications.
According to the presented case and subsequent literature review on fatal EBV hepatitis, clinicians should consider EBV infection in the differential diagnosis when hepatitis occurs in critically ill patients during the anti-TB therapy. Although hepatitis caused by EBV is mostly self-limited, some might be fetal.
尽管在抗结核治疗期间经常观察到肝炎，但应首先排除急性病毒性肝炎，尤其是在流行地区。除了常见的病毒性肝炎类型，即甲型肝炎病毒、乙型肝炎病毒和丙型肝炎病毒外，在某些情况下，爱泼斯坦-巴尔病毒（EBV）也可能导致肝炎。
在此，我们报告了一名危重症患者，该患者在抗结核治疗期间于重症监护病房发生胆汁淤积性肝炎，起初被误诊为抗结核药物性肝炎。进一步的血清学检查和肝活检确诊为EBV肝炎。与先前报道的EBV肝炎不同，先前报道的EBV肝炎表现为短暂性肝功能障碍和自限性疾病，而在我们的病例中，肝炎伴有进行性黄疸，随后出现凝血病和脑病，患者死于肝功能衰竭并发症。
根据所呈现的病例以及随后关于致命性EBV肝炎的文献综述，当危重症患者在抗结核治疗期间发生肝炎时，临床医生在鉴别诊断中应考虑EBV感染。尽管EBV引起的肝炎大多为自限性，但有些可能是致命的。
