Article

Severe hepatitis with autoimmune features following a HHV-6: a case report

Division of Infectious Disease, "Santa Caterina Novella" Hospital, Galatina, Italy. .
Cases Journal 02/2008; 1(1):110. DOI: 10.1186/1757-1626-1-110
Source: PubMed

ABSTRACT HHV-6 has been identified as the aetiologic agent of exanthem subitum in infants and an acute febrile illness in young children. HHV-6 probably remains latent in the body after the primary infection and it reactivates upon host immunosuppression in a manner similar to other human herpes viruses. Primary HHV-6 infection in adults is very rare and it is not clear whether disease manifestations are similar to those observed in children.
We report the case of acute hepatitis in a 18-year-old immunocompetent woman presenting with sever jaundice and liver dysfunction. Serum immunoglobulin levels were elevated (3.8 gr/dl) with a titre of anti nucleus antibody of 1:640. Serological data demonstrated the presence of IgM antibodies against human herpesvirus-6 in the serum and of viral DNA on liver biopsy by real time quantitative polymerase chain reaction, with a viral load of 280 genomes/106 of cellular genomes. No other etiologic agents were found to induce hepatitis and the patient was diagnosed as having HHV-6 triggered autoimmune acute hepatitis.

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    • "For those with advanced-stage disease and complications, consideration of liver transplantation is appropriate [6]. Hepatitis associated with HHV-6 infection was already described previously [7] [8]. In the current case, a portal lymphoplasmocytic infiltration and fibrosis was demonstrated in the liver explant despite the absence of reactivity to auto antibodies. "
    Journal of clinical virology: the official publication of the Pan American Society for Clinical Virology 03/2014; 60(1). DOI:10.1016/j.jcv.2014.03.008 · 3.47 Impact Factor
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    • "In the recent years, several reports have provided important information linking HHV-6A/B to autoimmune diseases (AD) including multiple sclerosis [1] [2] [3] [4] [5] [6] [7], autoimmune connective tissue diseases [8] [9] [10] [11], and Hashimoto's thyroiditis [12]. In addition, it has been suggested that HHV-6A/B infection might be related to the onset of autoimmune disorders , including Sjogren's syndrome [13], purpura fulminans, severe autoimmune acquired protein S deficiency [14], severe and acute autoimmune hepatitis [15] [16], and autoimmune hemolytic anemia/neutropenia [17]. The focus of this review is to discuss the above-mentioned AD associated with HHV-6 and the mechanisms proposed for HHV-6A/B-induced autoimmunity. "
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    ABSTRACT: Human herpesvirus 6 (HHV-6) infection is common and has a worldwide distribution. Recently, HHV-6A and HHV-6B have been reclassified into two distinct species based on different biological features (genetic, antigenic, and cell tropism) and disease associations. A role for HHV-6A/B has been proposed in several autoimmune disorders (AD), including multiple sclerosis (MS), autoimmune connective tissue diseases, and Hashimoto's thyroiditis. The focus of this review is to discuss the above-mentioned AD associated with HHV-6 and the mechanisms proposed for HHV-6A/B-induced autoimmunity. HHV-6A/B could trigger autoimmunity by exposing high amounts of normally sequestered cell antigens, through lysis of infected cells. Another potential trigger is represented by molecular mimicry, with the synthesis of viral proteins that resemble cellular molecules, as a mechanism of immune escape. The virus could also induce aberrant expression of histocompatibility molecules thereby promoting the presentation of autoantigens. CD46-HHV-6A/B interaction is a new attractive mechanism proposed: HHV-6A/B (especially HHV-6A) could participate in neuroinflammation in the context of MS by promoting inflammatory processes through CD46 binding. Although HHV-6A/B has the ability to trigger all the above-mentioned mechanisms, more studies are required to fully elucidate the possible role of HHV-6A/B as a trigger of AD.
    The Scientific World Journal 10/2013; 2013:867389. DOI:10.1155/2013/867389 · 1.73 Impact Factor
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    • "HHV-6 infection can be accompanied by convulsions and febrile status epilepticus. HHV-6 has been increasingly recognized as a cause of hepatitis and liver failure, as well as increased graft rejection and consequent decreased patient survival [20] [21] [22] [23] [24] [25] [26]. The rate of infection approaches 100% in individuals 2-3 years of age [21]. "
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    ABSTRACT: Background. There are challenges in the clinical diagnosis of drug-induced injury and in obtaining information on the reactivation of human herpes viruses (HHV) during idiosyncratic adverse drug reactions. Objectives. (i) To develop a unified list of drugs incriminated in drug-induced hepatotoxicity and severe cutaneous reactions, in which drug hypersensitivity leads to HHV-6 reactivation and further complication of therapy and recovery and (ii) to supplement the already available data on reporting frequencies of liver- or skin-induced cases with knowledge of individual case reports, including HHV-6 reactivation and briefly introducing chromosomally integrated HHV-6. Data Sources and Extraction. Drugs identified as causes of (i) idiosyncratic reactions, (ii) drug-induced hypersensitivity, drug-induced hepatotoxicity, acute liver failure, and Stevens-Johnson syndrome, and (iii) human herpes virus reactivation in PubMed since 1997 have been collected and discussed. Results. Data presented in this paper show that HHV-6 reactivation is associated with more severe organ involvement and a prolonged course of disease. Conclusion. This analysis of HHV-6 reactivation associated with drug-induced severe cutaneous reactions and hepatotoxicity will aid in causality assessment and clinical diagnosis of possible life-threatening events and will provide a basis for further patient characterization and therapy.
    05/2012; 2012:723062. DOI:10.1155/2012/723062
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