与人类疱疹病毒 6 感染相关的急性重症肝炎的临床和组织病理学特征

IF 4.5 1区 医学 Q1 PATHOLOGY
American Journal of Surgical Pathology Pub Date : 2024-09-01 Epub Date: 2024-06-21 DOI:10.1097/PAS.0000000000002266
Huiying Wang, Annette Vannilam, Einar T Hafberg, Lynette A Gillis, Ari Kassardjian, Bita V Naini, Vinay Prasad, David R Kelly, Elizabeth C Mroczek-Musulman, Konstance Knox, Hernan Correa, Jiancong Liang
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引用次数: 0

摘要

与活动性人类疱疹病毒 6(HHV-6)感染相关的急性重症肝炎是一种罕见的危及生命的疾病,其临床病程和组织病理学均不明确。在本研究中,我们回顾性分析了 5 例急性重症肝炎患者,他们在治疗过程中被发现有活动性肝 HHV-6 感染。所有患者之前都是健康儿童,出现非特异性前驱症状。其中四人出现急性肝衰竭(ALF),三人接受了肝移植手术。切除的肝脏和活组织检查显示,4例患者的肝脏呈中度至明显的中心性肝周炎和弥漫性中心性至泛球状坏死,伴有明显的肝细胞肿胀,3例患者的肝门部炎症较轻。与无 HHV-6 的 ALF 对照组相比,中央性肝周炎更为突出(P=0.01)。与近期爆发的腺病毒相关急性重症肝炎患儿相比,中心性肝周炎和中心叶坏死都是与 HHV-6 相关的重要预测因素(P=0.01)。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Clinical and Histopathologic Characteristics of Acute Severe Hepatitis Associated With Human Herpesvirus 6 Infection.

Acute severe hepatitis associated with active human herpesvirus 6 (HHV-6) infection is a rare life-threatening condition with unclear clinical course and histopathology. In this study, we retrospectively analyzed 5 patients with indeterminate acute severe hepatitis found to have active hepatic HHV-6 infection during care. All patients were previously healthy children presenting with a nonspecific prodrome. Four developed acute liver failure (ALF) and 3 received liver transplantation. The explanted livers and biopsies demonstrated a centrilobular pattern of necroinflammation characterized by moderate to marked central perivenulitis and confluent centrilobular to panlobular necrosis in 4 cases, accompanied by marked hepatocellular swelling and milder portal inflammation in 3. Central perivenulitis was more prominent in comparison to a control of group of ALF without HHV-6 ( P =0.01). When compared with the children with acute severe hepatitis associated with adenovirus encountered in the recent outbreak, both central perivenulitis and centrilobular necrosis were significant predictors for association with HHV-6 ( P <0.01). Liver immunohistochemistry detected HHV-6 structural protein in biliary epithelium in all cases and a predominance of CD8 + T cells in the perivenular inflammatory infiltrate. Among the 4 patients with ALF, one received early anti-HHV-6 therapy and had transplant-free survival, while the other 3 received either general prophylactic antiviral treatment only (n=2) or late anti-HHV-6 therapy (n=1) and needed liver transplantation. Our findings were similar to those in previously reported cases. In summary, acute severe hepatitis associated with HHV-6 tends to affect children, progress to ALF, and exhibit characteristic centrilobular necroinflammation which likely represents an immune-mediated process.

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来源期刊
CiteScore
10.30
自引率
5.40%
发文量
295
审稿时长
1 months
期刊介绍: The American Journal of Surgical Pathology has achieved worldwide recognition for its outstanding coverage of the state of the art in human surgical pathology. In each monthly issue, experts present original articles, review articles, detailed case reports, and special features, enhanced by superb illustrations. Coverage encompasses technical methods, diagnostic aids, and frozen-section diagnosis, in addition to detailed pathologic studies of a wide range of disease entities. Official Journal of The Arthur Purdy Stout Society of Surgical Pathologists and The Gastrointestinal Pathology Society.
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