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Clinical features of children with Epstein-Barr virus-related acute liver failure: an analysis of four cases
LIU Rui-Hai, LI Jing, QU Ni-Yan, LI Zi-Pu
Chinese Journal of Contemporary Pediatrics ›› 2018, Vol. 20 ›› Issue (12) : 1030-1033.
PDF(1124 KB)
PDF(1124 KB)
Clinical features of children with Epstein-Barr virus-related acute liver failure: an analysis of four cases
A retrospective analysis was performed for the clinical data of four children with Epstein-Barr virus (EBV)-related acute liver failure. There were two boys and two girls with a median age of 10 months (range 8.5-44 months). Of the four children, three were diagnosed with infectious mononucleosis (IM), among whom two met the diagnostic criteria of hemophagocytic lymphohistiocytosis (HLH), and one was diagnosed with past EBV infection. All the children had positive EBV DNA in blood and all had pyrexia, hepatomegaly, and jaundice on admission. Three children had the symptom of splenomegaly, ascites, or vomiting. Two children had enlargement of cervical lymph nodes, skin rash, or pleural effusion. One child had gastrointestinal bleeding or stage 2 hepatic encephalopathy. All the children had an abnormal lymphocyte count of < 10%, and only one child had leukocytosis and thrombocytopenia. Among the four children, alanine aminotransferase level increased by 10-100 times; total bilirubin level increased by 3-5 times; lactate dehydrogenase level increased by many 10 times; prothrombin time prolonged significantly. All the children were given antiviral therapy with intravenously injected acyclovir or ganciclovir, as well as hepatocyte growth factor to promote hepatocyte growth and hormone to alleviate inflammatory response. Two children were given plasma exchange in addition, among whom one was given the combination of continuous venovenous hemodiafiltration. Two children with HLH were given chemotherapy according to the HLH-2004 regimen. Three children survived, and one child with HLH died of multiple organ failure. It is concluded that EBV infection can cause acute liver failure and that early use of multimodality therapy including blood purification may be beneficial for prognosis in these children.
Acute liver failure / Viral hepatitis / Epstein-Barr virus / Child
[1] 李晓卿, 黄敬孚. 儿童急性肝功能衰竭的诊疗进展[J]. 医学综述, 2015, 21(4):674-676.
[2] 裴亮, 文广富, 郭张妍, 等. 儿童急性肝功能衰竭短期预后的影响因素[J]. 中国当代儿科杂志,2014, 16(12):1250-1254.
[3] Squires RH Jr, Shneider BL, Bucuvalas J, et al. Acute liver failure in children:the first 348 patients in the pediatric acute liver failure study group[J]. J Pediatr, 2006, 148(5):652-658.
[4] 高立伟, 谢正德, 幺远, 等. 儿童EB病毒感染传染性单核细胞增多症的临床特征[J]. 实用儿科临床杂志, 2010, 25(10):725-727.
[5] 中华医学会儿科学分会感染学组, 全国儿童EB病毒感染协作组. 儿童主要非肿瘤性EB病毒感染相关疾病的诊断和治疗原则建议[J]. 中华儿科杂志, 2016, 54(8):563-568.
[6] Mellinger JL, Rossaro L, Naugler WE, et al. Epstein-Barr virus (EBV) related acute liver failure:a case series from the US Acute Liver Failure Study Group[J]. Dig Dis Sci, 2014, 59(7):1630-1637.
[7] Henter JI, Horne A, Arico M, et al. HLH-2004:Diagnostic and therapeutic guidelines for hemophagocytic lymphohistiocytosis[J]. Pediatr Blood Cancer, 2007, 48(2):124-131.
[8] Yang SI, Geong JH, Kim JY. Clinical characteristics of primary Epstein-Barr virus hepatitis with elevation of alkaline phosphatase and γ-glutamyltransferase in children[J]. Yonsei Med J, 2014, 55(1):107-112.
[9] Crum NF. Epstein Barr virus hepatitis:case series and review[J]. South Med J, 2006, 99(5):544-547.
[10] 刘钢. 儿童EB病毒肝炎治疗[J]. 中国实用儿科杂志, 2015, 30(5):343-346.
[11] 霍黎, 李强. EB病毒感染相关性噬血细胞性淋巴组织细胞增生症的研究进展[J]. 国际输血及血液学杂志, 2012, 35(4):297-304.
[12] 陶佳, 陈福雄, 陈德辉, 等. 儿童EB病毒感染及传染性单核细胞增多症临床特点和实验室检查分析[J]. 中国实用儿科杂志, 2013, 28(3):200-203.
[13] Singer AL, Olthoff KM, Kim H, et al. Role of plasmapheresis in the management of acute hepatic failure in children[J]. Ann Surg, 2001, 234(3):418-424.
[14] 戎群芳, 张育才, 朱艳, 等. 连续性静-静脉血液净化辅助治疗儿童急性肝功能衰竭5例临床分析[J]. 中国实用儿科杂志, 2011, 26(4):272-273.
[15] 许煊, 余帮, 祝彬, 等. 血液净化(人工肝)在急性肝功能衰竭患儿中的临床应用[J].中华儿科杂志, 2014, 52(6):433-437.
[16] Nakazawa A, Nakano N, Fukuda A, et al. Use of serial assessment of disease severity and liver biopsy for indication for liver transplantation in pediatric Epstein-Barr virus-induced fulminant hepatic failure[J]. Liver Transpl, 2015, 21(3):362-368.
[17] Zhao P, Wang CY, Liu WW, et al. Acute liver failure in Chinese children:a multicenter investigation[J]. Hepatobiliary Pancreat Dis Int, 2014, 13(3):277-280.
[18] Deep A, Stewart CE, Dhawan A, et al. Effect of continuous renal replacement therapy on outcome in pediatric acute liver failure[J]. Crit Care Med, 2016, 44(10):1910-1919.
