Postinfantile giant cell hepatitis with autoimmune features following a human herpesvirus 6-induced adverse drug reaction

Area of Science:

• Hepatology
• Immunology
• Virology

Background:

• Giant cell hepatitis (GCH) is a rare liver disease, primarily affecting neonates, characterized by multinucleated giant cells in the liver.
• Adult GCH is uncommon, often presents fulminantly, and its etiology is poorly understood, with associations to autoimmune disorders, viral infections, and drug reactions.
• Current therapeutic strategies for GCH remain controversial due to unclear pathogenesis.

Observation:

• A rare case of adult GCH was observed with concurrent autoimmune features.
• The patient experienced GCH following an adverse drug reaction triggered by human herpesvirus 6 (HHV6).
• This specific combination of GCH, HHV6-induced drug reaction, and autoimmune features has not been previously reported.

Findings:

• The patient presented with GCH and autoimmune manifestations.
• A causative link was established between HHV6 infection, an adverse drug reaction, and the subsequent development of GCH.
• High-dose immunosuppressive therapy resulted in significant clinical improvement.

Implications:

• This case expands the known etiological spectrum of adult GCH.
• It suggests a potential role for HHV6 and drug reactions in GCH pathogenesis, particularly in patients with autoimmune predispositions.
• The successful use of immunosuppression offers a potential therapeutic avenue for similar complex GCH cases.