Epstein - Barr virus Infection as a Trigger of Autoimmune Hepatitis: Case Report

Daniela Cabibi ,S Scaduti,Matilde Cacciatore ,Francesca Di Gaudio

doi:10.3844/ajidsp.2008.200.203

Abstract

The study underlines the importance of the differential diagnosis between primary Epstein-Barr virus EBV associated hepatitis with features of autoimmunity, in which there is a direct pathogenetic role of the virus, and EBV related autoimmune hepatitis, in which EBV could act as the trigger of the immune-mediated damage with probable differences between the two conditions with regard to the prognosis and the responsiveness to immunosuppressive treatment. Moreover we hypothesise that the favourable outcome in our patient, better than the most of autoimmune hepatitis cases, may be related either to the moderate necroinflammatory activity and to the low level of fibrosis at the beginning of the disease or to the role of EBV as a trigger of autoimmune hepatitis. The hypothesis that EBV-related autoimmune hepatitis could have a more favourable prognosis than the most of autoimmune hepatitis cases in general need to be confirmed on a larger series of studies.

Highlights

Several hepatotropic viruses have been postulated as inducers of autoimmune hepatitis (AIH) in susceptible subjects[1,2,3,4,5]
Autoimmune hepatitis is usually an aggressive disease that leads to cirrhosis and has a mortality of up to 50 percent within 2 to 4 years
AIH usually is as an aggressive disease leading to cirrhosis and with a mortality of up to 50 percent within 2 to 4 years and for which indefinite therapy is often required, the unfavorauble outcome of which is related to high inflammatory activity and severe fibrosis on liver biopsy

Summary

INTRODUCTION

Several hepatotropic viruses have been postulated as inducers of autoimmune hepatitis (AIH) in susceptible subjects[1,2,3,4,5]. The Epstein-Barr virus (EBV) is among these agents[6,7,8,9] but the number of patients reported is small and, to our knowledge, there is little information on the clinical evolution of the disease in such patients. The present report describes a young man that, 16 months after the recovery of acute hepatitis E, was infected with EBV and 4 months after developed autoimmune hepatitis

CASE REPORT

Findings

DISCUSSION