A case of rapid deterioration from acute liver failure possibly due to Epstein-Barr virus reactivation

Abstract

A woman in her late teens was being treated with prednisolone and azathioprine for autoimmune demyelinated disorder when she developed drug erythema 2 weeks before admission. Her skin symptoms improved after the drug was discontinued; however, she developed fever and nausea within a week. Laboratory tests revealed that her liver enzymes were elevated, and she was admitted to our department for acute liver injury. Serological tests revealed no evidence of viral hepatitis, and drug-induced liver damage was suspected. On the 8^th hospital day, she developed hepatic encephalopathy with a PT-INR of 2.32. Steroid pulse therapy and continuous hemodiafiltration were initiated for acute liver failure (ALF) and she was placed on the waiting list for liver transplantation. Despite intensive treatment, she developed irreversible brain edema on the 10^th hospital day. We later discovered that serum EBV-DNA (3.3 LogIU/mL) was positive. EBV infection is a rare but severe cause of ALF in adults. Thus, EBV reactivation should be considered in the differential diagnosis of ALF from an unknown cause.