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Previous Volume 359:593-602 August 7, 2008 Number 6 Next

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SUMMARY

Syncytial giant-cell hepatitis is a rare but severe form of hepatitis that is associated with autoimmune diseases, drug reactions, and viral infections. We used serologic, molecular, and immunohistochemical methods to search for an infectious cause in a case of syncytial giant-cell hepatitis that developed in a liver-transplant recipient who had latent infection with variant B of human herpesvirus 6 (HHV-6B) and who had received the organ from a donor with variant A latent infection (HHV-6A). At the onset of the disease, the detection of HHV-6A (but not HHV-6B) DNA in plasma, in affected liver tissue, and in single micromanipulated syncytial giant cells with the use of two different polymerase-chain-reaction (PCR) assays indicated the presence of active HHV-6A infection in the patient. Expression of the HHV-6A–specific early protein, p41/38, but not of the HHV-6B–specific late protein, p101, was demonstrated only in liver syncytial giant cells in the absence of other infectious pathogens. The same markers of HHV-6A active infection were documented in serial follow-up samples from the patient and disappeared only at the resolution of syncytial giant-cell hepatitis. Neither HHV-6B DNA nor late protein was identified in the same follow-up samples from the patient. Thus, HHV-6A may be a cause of syncytial giant-cell hepatitis.

Source Information

From the Department of Oncology and Hematology (L.P., M.L., P.B., G.T.), the Integrated Department of Diagnostic and Laboratory Services and Legal Medicine (G.R., M. Pecorari, W.G., M. Portolani), the Department of Internal Medicine and Medical Specialties (S.C., M.C., G.G.), and the Liver and Multivisceral Transplant Center (M.M., F.D.B., G.E.G.) — all at the University of Modena and Reggio Emilia, Azienda Ospedaliera Policlinico, Modena; and the Department of Clinical and Experimental Medicine, University of Bologna, and St. Orsola Malpighi General Hospital, Bologna (T.L., M.P.L.) — all in Italy; and the Department of Virology, Hannover Medical School, Hannover, Germany (T.F.S.).

Drs. Potenza, Luppi, and Barozzi contributed equally to this article.

Address reprint requests to Dr. Luppi at the Department of Oncology and Hematology, University of Modena and Reggio Emilia, Azienda Ospedaliera Policlinico, Via del Pozzo 71, 41100 Modena, Italy, or at mario.luppi{at}unimore.it.

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