- 期刊
Reactivation of Herpes Simplex Causing Submassive Hepatic Necrosis in a Liver Recipient
肝移植術後因單純疱疹再發造成亞大片性肝壞死：病例報告
摘要
肝移植病人因庖疹病毒引發次發性大片肝壞死而存活者很少。一位四十八歲因B型肝炎肝硬化而接受活體肝移植的病人，在術後兩個月時，因持續進行性黃膽而再次入院檢查。少量血液中B型肝炎病毒突變的發現，但病人對藥物的反應不佳。先後相隔兩個月的再次肝組織切片檢查才證實是第一型疱疹病毒引起的肝衰竭。血清學的檢查在術前術後都呈陽性，顯示是再發的病毒感染。長期投予靜脈注射acyclovlr後，病人的肝功能才漸漸回到正常。回顧第一次的檢體，採用特殊免疫染色和RT-PCR技術皆無法偵測到庖疹病毒。病人也沒有典型水皰、白血球及血小板減少的現象。因此盡早診斷很重要，但非常不容易。臨床上不確定的情況下，隨時要重新評估並作出適當的治療決定才不會延誤病情。
關鍵字
無資料並列摘要
Survival from herpes simplex virus (HSV)-induced submassive hepatic necrosis in a liver recipient is rare. A 48-year-old man, with underlying HBV-related liver cirrhosis underwent living-related liver transplantation, had progressive hyperbilirubinemia and hepatic failure which occurred 2 months after surgery. Small amounts of YMDD mutated HBV DNA were found in serum but the patient responded poorly to lamivudin plus adefovir. Two sequential liver biopsies were performed and only the second one was characteristic of submassive hepatic necrosis with a Cowdry type I intranuclear inclusion body, which was confirmed to be HSV type I infection by immunohistochemistry. Retrospective immuno-staining and DNA detection by real time PCR of the first specimen were both negative. Serologic antibody titers were positive pre-and post-operatively. Intravenous acyclovir was administered and the liver function dramatically recovered. There were no clinical signs of oral or genital reactivation of HSV, fever, leucopenia, or thrombocytopenia. Early diagnosis was vital but difficult. Reevaluation and therapeutic decisions should not be delayed in clinically undetermined situations.
延伸閱讀
- Yu, P. C., Cheng, Y. F., Lee, T. Y., Hsu, S. W., & Eng, H. L. (1997). 原發性肝淋巴瘤併發針途徑轉移：病例報告. 中華放射線醫學雜誌, 22(2), 75-77. https://www.airitilibrary.com/Article/Detail?DocID=10188940-199704-22-2-75-77-a
- 王以仁、潘廣勤、陳儉鏗、朱海榮（1993）。肝硬化合併發炎性肝偽瘤破裂：一病例報告。中華民國消化系醫學會雜誌，10(2)，178-183。https://doi.org/10.6557/GJTa.199306_10(2).0008
- Lin, C. L., Chang, J. L., & Cheng, Y. W. (2009). 根瘤菌引起之肝膿瘍與敗血性休克：一病例報告. 臺灣消化醫學雜誌, 26(4), 326-329. https://doi.org/10.6557/GJT.200912_26(4).0009
- Lin, H. P., Lin, K. T., Ho, W. C., Chen, C. B., & Lin, Y. C. (2012). 以射頻燒灼術重複治療單一肝細胞癌併發腹腔內遠端轉移：兩病例報告. 臺灣消化醫學雜誌, 29(3), 299-302. https://doi.org/10.6557/GJT.201209_29(3).0005
- Chang, J. J., Chen, L. W., Liu, C. J., Yen, C. L., & Chien, R. N. (2011). 免疫機能健全之B型肝炎帶原者產生單純疱疹病毒性食道炎：一病例報告. 臺灣消化醫學雜誌, 28(2), 225-228. https://doi.org/10.6557/GJT.201106_28(2).0005