Severe hepatitis associated with an echovirus 18 infection in an immune-compromised adult

Abstract

Enteroviruses are recognized as important pathogens in pediatric patients; however, they are often overlooked as etiologic agents of disease in adults. Here, we report a case of echovirus 18-associated severe systemic infection and acute liver failure in an adult hematopoietic stem cell transplant recipient. Additionally, we illustrate the utility of molecular methods for the detection and typing of enteroviral infections.

Fig 1

Time course of the patient's presentation. Shown are major clinical events in the patient's clinical course both before and after he presented to our hospital. Timeline is not to scale. NHL, non-Hodgkin lymphoma; HSCT, hematopoietic stem cell transplant; OSH, outside hospital; PLEX, plasma exchange/plasmapheresis; LFTs, liver function tests; CSF, cerebrospinal fluid; IFA, indirect immunofluorescence antibody testing.

Fig 2

Liver function tests during the patient's hospitalization. Levels of the patient's aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase are shown relative to the day of hospitalization. The values in parentheses represent the upper limit of normal for each analyte. Also indicated is the timing of lumbar puncture (LP), the second round of plasma exchange (PLEX), and the second liver biopsy, as well as the time at which enterovirus (EV) was detected in the patient's cerebrospinal fluid (CSF) by viral culture.