Associates' Presentations
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Fulminant hepatic failure in an immunocompromised patient.
Jeffrey J. Jones, M.D., (Associate), Gundersen Lutheran, LaCrosse, Wisconsin
A 36-year-old woman with a history of idiopathic pulmonary fibrosis on immunosuppressive therapy was referred for fever, abdominal discomfort, and nausea. Liver tests were obtained at the referring hospital and acute cholecystitis was diagnosed.
A right upper quadrant ultrasound was normal and the patient was continued on antibiotics. Diarrhea developed and the patient's liver tests continued to rise. Various cultures were unrevealing. Septic shock developed clinically and despite aggressive support the woman expired. Autopsy revealed submassive necrosis of the liver due to adenovirus infection.
Adenoviruses have been associated with upper respiratory tract infections in children and adults. Adenoviruses have been identified as pathogens in immunocompromised patients and should be considered in severe illness in those individuals. The clinical syndrome and differential diagnosis will be discussed.
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