Christian Vikram J, Sarwar Raiya, Resch Joseph C, Lim Sarah, Somani Arif, Larson-Nath Catherine, McAllister Shane, Thielen Beth K, Adeyi Oyedele, Chinnakotla Srinath, Bhatt Heli
Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA.
Department of Medicine, Division of Transplant Hepatology, University of Minnesota, Minneapolis, Minnesota, USA.
Case Rep Transplant. 2022 Nov 9;2022:9426175. doi: 10.1155/2022/9426175. eCollection 2022.
Since October 2021, there have been more than 500 cases of severe hepatitis of unknown origin in children reported worldwide, including 180 cases in the U.S. The most frequently detected potential pathogen to date has been adenovirus, typically serotype 41. Adenovirus is known to cause a self-limited infection in the immunocompetent host. However, in immunosuppressed individuals, severe or disseminated infections may occur.
We present the case of a two-year-old female who presented with cholestatic hepatitis and acute liver failure (ALF). Work up for etiologies of ALF was significant for adenovirus viremia, but liver biopsy was consistently negative for the virus. The risk for severe adenoviral infection in the setting of anticipated immunosuppression prompted us to initiate cidofovir to decrease viral load prior to undergoing liver transplantation.
Our patient received a successful liver transplant, cleared the viremia after 5 doses of cidofovir, and continues to maintain allograft function without signs of infection at the time of this report, 5 months posttransplant.
Recent reports of pediatric hepatitis cases may be associated with adenoviral infection although the exact relationship is unclear. There is the possibility of the ongoing SARS-CoV-2 environment, or other immunologic modifying factors. All patients presenting with hepatitis or acute liver failure should be screened for adenovirus and reported to state health departments. Cidofovir may be used to decrease viral load prior to liver transplantation, to decrease risk of severe adenoviral infection.
自2021年10月以来，全球报告了500多例病因不明的儿童重症肝炎病例，其中美国有180例。迄今为止，最常检测到的潜在病原体是腺病毒，通常为41型。已知腺病毒在免疫功能正常的宿主中会引起自限性感染。然而，在免疫抑制个体中，可能会发生严重或播散性感染。
我们报告了一名两岁女性患者，她表现为胆汁淤积性肝炎和急性肝衰竭（ALF）。对ALF病因的检查显示腺病毒血症，但肝活检一直未检测到该病毒。鉴于预期的免疫抑制情况下发生严重腺病毒感染的风险，我们在患者进行肝移植前启动了西多福韦治疗以降低病毒载量。
我们的患者成功接受了肝移植，在接受5剂西多福韦后病毒血症清除，在本报告时（移植后5个月）仍维持移植肝功能且无感染迹象。
近期儿童肝炎病例报告可能与腺病毒感染有关，尽管确切关系尚不清楚。有可能与持续的SARS-CoV-2环境或其他免疫调节因素有关。所有出现肝炎或急性肝衰竭的患者都应进行腺病毒筛查，并向州卫生部门报告。西多福韦可用于在肝移植前降低病毒载量，以降低严重腺病毒感染的风险。
