Zusammenfassung
Einleitung: Obwohl effektive Therapien zur Verfügung stehen, hat eine fulminante durch Varizella-Zoster-Virus-(VZV-)Infektion induzierte Hepatitis eine schlechte Prognose. Kasuistik: Wir präsentieren den Fall eines alkoholkranken Patienten mit akutem Leberversagens als Folge einer disseminierten VZV-Infektion. Der Patient hatte sich aufgrund eines Larynxkarzinoms einer Laryngektomie mit radikaler Neck dissection unterzogen. Die Obduktion ergab die Diagnose einer VZV-Infektion mit fulminanter Hepatitis. Virale Einschlusskörper wurden in der Schleimhaut des Hypopharynx und im Lebergewebe nachgewiesen. In diesen Geweben konnte ein Virusnachweis mittels PCR erbracht werden. Der klinische Verlauf deutet in erster Linie auf eine Reaktivierung von VZV unter Immunsuppression hin, auch wenn keine typische dermale Manifestation eines Herpes zoster erkennbar war. Diskussion: Die Differenzialdiagnosen in diesem Fall umfassen Hepatitiden durch andere Mitglieder der Herpes-Virus-Familie und auch einen toxischen Leberparenchymschaden.
Abstract
Introduction: Fulminant hepatitis due to varicella zoster virus (VZV) infection has a poor prognosis although an effective treatment is available. Case Report: We present a case of fulminant hepatic failure (FHF) as a result of disseminated VZV infection in a long-term alcoholic patient who underwent laryngectomy and radical neck dissection due to squamous cell carcinoma of the larynx. Post-mortem examination revealed the diagnosis of fulminant hepatitis and infection with VZV. Viral inclusion bodies were found in the hypopharyngeal mucosa as well as in the liver tissue. In these tissues VZV was detected by PCR. The clinical presentation is suggestive for a reactivation of VZV without cutaneous signs of herpes zoster during a state of immunosuppression. Discussion: Differential diagnosis comprises hepatitis by other Herpes group viruses and toxic hepatic injury.
Schlüsselwörter
Virushepatitis - Varizella-Zoster-Virus - akutes Leberversagen
Key words
viral hepatitis - varicella zoster virus - acute liver failure
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Uta Drebber
Institute of Pathology, University of Cologne
Joseph-Stelzmann-Str. 9
50931 Cologne
Germany
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eMail: u.drebber@uni-koeln.de
