Adenovirus hepatitis presenting as tumoral lesions in an immunocompromised patient
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"documento" => "article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Ann Hepatol. 2014;13:819-26" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 107 "formatos" => array:3 [ "EPUB" => 11 "HTML" => 62 "PDF" => 34 ] ] "en" => array:11 [ "idiomaDefecto" => true "titulo" => "The risk of carcinogenesis in congenital choledochal cyst patients: an analysis of 214 cases" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "819" "paginaFinal" => "826" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "f0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 321 "Ancho" => 891 "Tamanyo" => 33123 ] ] "descripcion" => array:1 [ "en" => "<p id="sp0005" class="elsevierStyleSimplePara elsevierViewall">No. 5 patient, M/38, who had undergone an internal drainage with cystoduodenostomy 37 years ago, presented to our institution with vomiting after meal. A. MRCP showed extrahepatic bile duct disrupted (arrow). B. CT manifested a mass (arrow) deriving from bilioenteric anastomotic stoma. An exploratory surgery and biopsy revealed low-differentiated adenocarcinoma of distal bile duct.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Xiao-Dong He, Lei Wang, Wei Liu, Qi Liu, Qiang Qu, Bing-Lu Li, Tao Hong" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Xiao-Dong" "apellidos" => "He" ] 1 => array:3 [ "preGrado" => "M.D., Ph.D." "nombre" => "Lei" "apellidos" => "Wang" ] 2 => array:2 [ "nombre" => "Wei" "apellidos" => "Liu" ] 3 => array:2 [ "nombre" => "Qi" "apellidos" => "Liu" ] 4 => array:2 [ "nombre" => "Qiang" "apellidos" => "Qu" ] 5 => array:2 [ "nombre" => "Bing-Lu" "apellidos" => "Li" ] 6 => array:2 [ "nombre" => "Tao" "apellidos" => "Hong" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665268119309858?idApp=UINPBA00004N" "url" => "/16652681/0000001300000006/v1_201906150917/S1665268119309858/v1_201906150917/en/main.assets" ] "en" => array:17 [ "idiomaDefecto" => true "titulo" => "Adenovirus hepatitis presenting as tumoral lesions in an immunocompromised patient" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "827" "paginaFinal" => "829" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Juan Putra, Arief A. Suriawinata" "autores" => array:2 [ 0 => array:5 [ "preGrado" => "M.D." "nombre" => "Juan" "apellidos" => "Putra" "email" => array:1 [ 0 => "Juan.Putra@Hitchcock.org" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Arief A." "apellidos" => "Suriawinata" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:3 [ "entidad" => "Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, United States" "etiqueta" => "*" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "*" "correspondencia" => "Correspondence and reprint request:" ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "f0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 362 "Ancho" => 435 "Tamanyo" => 47599 ] ] "descripcion" => array:1 [ "en" => "<p id="sp0015" class="elsevierStyleSimplePara elsevierViewall">Diffuse positive immunostaining for adenovirus antibody confirmed the diagnosis, adenovirus antibody (x 200).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="s0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0015">Case Presentation</span><p id="p0005" class="elsevierStylePara elsevierViewall">A 59-year old man with T-cell prolymphocytic leukemia on alemtuzumab presented with neutropenic fever. His past medical history was significant for hepatitis C and splenectomy several years ago due to splenic involvement of diffuse large B cell lymphoma. His febrile and intermittent nausea persisted despite several days of cephalosporin therapy. No localized signs or symptoms of infection were identified on the physical examination. The laboratory analysis was significant for leukopenia (0.3 x 10<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>/mcL) and transaminitis (ALT 87 U/L, AST 284 U/L). Meanwhile, other liver function tests were within normal limits (total bilirubin 0.3 mg/dL, alkaline phosphatase 75 U/L, albumin 3.2 g/dL, and total protein 7.8 g/dL). Computed tomography scan of the abdomen with contrast revealed multiple hypodense lesions in the liver (<a class="elsevierStyleCrossRef" href="#f0005">Figure 1</a>). The largest lesion was seen in the posterior right lobe, measuring approximately 4.4 cm. Differential diagnosis included metastatic lesions, and less likely infectious etiology. Computed tomography-guided needle core biopsy of the lesions revealed numerous hepatocytes with smudgy nuclear appearance (<a class="elsevierStyleCrossRef" href="#f0010">Figure 2</a>), which were characteristic of adenovirus infections. Diagnosis of adenovirus hepatitis was also confirmed by diffuse immunostaining (<a class="elsevierStyleCrossRef" href="#f0015">Figure 3</a>). In addition, quantitative polymerase chain reaction revealed high-copy number of adenovirus DNA (2,000,000 copies/mL) and culture of the liver biopsy was positive for adenovirus. Treatment with cidofovir improved his condition dramatically. Adenovirus DNA detection by quantitative polymerase chain reaction was within normal range (< 500 copies/mL) 3 months after the treatment was initiated.</p><elsevierMultimedia ident="f0005"></elsevierMultimedia><elsevierMultimedia ident="f0010"></elsevierMultimedia><elsevierMultimedia ident="f0015"></elsevierMultimedia></span><span id="s0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0020">Discussion</span><p id="p0010" class="elsevierStylePara elsevierViewall">Adenovirus, a double-stranded DNA virus, is a common cause of self-limiting upper respiratory infection in immunocompetent patients.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Adenovirus infections occur more frequently in immunocompromised patients and may result in more severe manifestations, such as pneumonia, nephritis, hepatitis, encephalitis, pancreatitis, or disseminated disease.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">–</span><a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The reported incidence of adenovirus infections in immunosuppressed patients ranges from 3 to 21%.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Different methods can be utilized to diagnose adenovirus hepatitis. The imaging features of acute hepatitis are often nonspecific. The most essential role of radiology in patients with suspected hepatitis is to help rule out other etiologies. The nonspecific findings on computed-tomography and magnetic resonance imaging include hepatomegaly and periportal edema. On computed-tomography, heterogeneous enhancement and well-defined regions of low attenuation may be present. Meanwhile, periportal edema appears as high-signal-intensity areas on T2-weighted images on magnetic resonance imaging.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Familiarity with the most relevant radiologic key features, combined with critical clinical information may provide enough information to characterize the lesion and differentiate it from other types of focal lesion (neoplastic and developmental). Adenoviral infections can also be diagnosed using enzyme-linked immunosorbent assay or immunofluorescence assay, complement fixation test or viral culture.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> However, these patients often require tissue biopsy to render a definitive diagnosis. The histologic hallmark of adenovirus infection in the liver is the presence of patchy necrosis with “blueberry” basophilic intranuclear inclusions in the hepatocytes, which often referred as smudge cells.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Furthermore, immunohis-tochemistry is useful to confirm the microscopic findings. We demonstrated that adenovirus hepatitis may present as tumoral lesions on computed tomography scan. Furthermore, timely diagnosis is essential to obtain favorable outcomes.</p></span><span id="s0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0025">Conflict of Interest</span><p id="p0015" class="elsevierStylePara elsevierViewall">Both authors have nothing to disclose.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:6 [ 0 => array:3 [ "identificador" => "xres1207232" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abs0010" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1124278" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "s0005" "titulo" => "Case Presentation" ] 3 => array:2 [ "identificador" => "s0010" "titulo" => "Discussion" ] 4 => array:2 [ "identificador" => "s0015" "titulo" => "Conflict of Interest" ] 5 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-05-12" "fechaAceptado" => "2014-07-16" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1124278" "palabras" => array:5 [ 0 => "Viral hepatitis" 1 => "Acute liver injury" 2 => "Liver biopsy" 3 => "Imaging studies" 4 => "Cidofovir" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abs0010" class="elsevierStyleSection elsevierViewall"><p id="sp0020" class="elsevierStyleSimplePara elsevierViewall">A 59-year-old man with T-cell prolymphocytic leukemia on alemtuzumab presented with neutropenic fever, intermittent nausea, and multiple ill-defined low attenuation foci in the liver on abdominal computed tomography scan which were suspicious for metastatic disease. Histological examination revealed the diagnosis of adenovirus hepatitis. Patient responded well to cidofovir. Adenovirus hepatitis is a rare but important entity to be considered by the clinicians, radiologists, and pathologists. Timely diagnosis and appropriate management are essential to improve the prognosis of adenovirus hepatitis in immunocompromised patients.</p></span>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "f0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 692 "Ancho" => 498 "Tamanyo" => 39316 ] ] "descripcion" => array:1 [ "en" => "<p id="sp0005" class="elsevierStyleSimplePara elsevierViewall">A and B. Abdominal CT scan revealed multiple hypodensities in the liver, which were suspicious for metastatic disease.</p>" ] ] 1 => array:7 [ "identificador" => "f0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 362 "Ancho" => 504 "Tamanyo" => 50348 ] ] "descripcion" => array:1 [ "en" => "<p id="sp0010" class="elsevierStyleSimplePara elsevierViewall">Biopsy of one of the lesions showed hepatocytes with enlarged and dark smudge cells which were characteristic of adenovirus infections, H&E (x 200).</p>" ] ] 2 => array:7 [ "identificador" => "f0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 362 "Ancho" => 435 "Tamanyo" => 47599 ] ] "descripcion" => array:1 [ "en" => "<p id="sp0015" class="elsevierStyleSimplePara elsevierViewall">Diffuse positive immunostaining for adenovirus antibody confirmed the diagnosis, adenovirus antibody (x 200).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bs0010" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fatal adenoviral hepatitis after rituximab therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "Iyer A." 1 => "Mathur R." 2 => "Deepak B.V." 3 => "Sinard J." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1043/1543-2165(2006)130[1557:FAHART]2.0.CO;2" "Revista" => array:6 [ "tituloSerie" => "Arch Pathol Lab Med" "fecha" => "2006" "volumen" => "130" "paginaInicial" => "1557" "paginaFinal" => "1560" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17090202" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fulminant hepatitis due to adenovirus" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:7 [ 0 => "Ronan B.A." 1 => "Agrwal N." 2 => "Carey E.J." 3 => "De Petris G." 4 => "Kusne S." 5 => "Seville M.T." 6 => "Blair J.E." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s15010-013-0527-7" "Revista" => array:6 [ "tituloSerie" => "Infection" "fecha" => "2014" "volumen" => "42" "paginaInicial" => "105" "paginaFinal" => "111" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23979854" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fulminant adenovirus hepatitis following bone marrow transplantation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Wang W.H." 1 => "Wang H.L." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Arch Pathol Lab Med" "fecha" => "2003" "volumen" => "127" "paginaInicial" => "246" "paginaFinal" => "248" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The infected liver: radio-logic-pathologic correlation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Mortele K.F." 1 => "Segatto E." 2 => "Ros P.R." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Radiographics" "fecha" => "2004" "volumen" => "4" "paginaInicial" => "937" "paginaFinal" => "955" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute and chronic hepatitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Suriawinata A.A." 1 => "Thung S.N." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Semin Diagn Pathol" "fecha" => "2006" "volumen" => "23" "paginaInicial" => "132" "paginaFinal" => "148" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17355087" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/16652681/0000001300000006/v1_201906150917/S166526811930986X/v1_201906150917/en/main.assets" "Apartado" => array:4 [ "identificador" => "77922" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in Hepatology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/16652681/0000001300000006/v1_201906150917/S166526811930986X/v1_201906150917/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S166526811930986X?idApp=UINPBA00004N" ]
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