Article
Late-Relapsing Hepatitis After Yellow Fever
Registro en:
REZENDE, Izabela Maurício et al. Late-Relapsing Hepatitis After Yellow Fever. Case Reports Viruses, v. 12, n. 2, 222, 2020.
1999-4915
10.3390/v12020222
Autor
Rezende, Izabela Maurício
Pereira, Leonardo Soares
Fradico, Jordana Rodrigues Barbosa
Xavier, Marcelo Antônio Pascoal
Alves, Pedro Augusto
Azevedo, Ana Carolina Campi
Speziali, Elaine
Santos, Lívia Zignago Moreira Dos
Albuquerque, Natalia Soares
Penido, Indiara
Santos, Tayrine Araujo
Bom, Ana Paula Dinis Ano
Silva, Andrea Marques Vieira da
Fernandes, Camilla Bayma
Calzavara, Carlos Eduardo
Kroon, Erna Geessien
Martins Filho, Olindo Assis
Carvalho, Andréa Teixeira de
Drumond, Betânia Paiva
Resumen
One patient presented hyporexia, asthenia, adynamia, and jaundice two months after acute yellow fever (YF) onset; plus laboratory tests indicating hepatic cytolysis and a rebound of alanine and aspartate transaminases, and total and direct bilirubin levels. Laboratory tests discarded autoimmune hepatitis, inflammatory or metabolic liver disease, and new infections caused by hepatotropic agents. Anti-YFV IgM, IgG and neutralizing antibodies were detected in different times, but no viremia. A liver biopsy was collected three months after YF onset and tested positive for YFV antigens and wild-type YFV-RNA (364 RNA-copies/gram/liver). Transaminases and bilirubin levels remained elevated for five months, and the arresting of symptoms persisted for six months after the acute YF onset. Several serum chemokines, cytokines, and growth factors were measured. A similar immune response profile was observed in the earlier phases of the disease, followed by more pronounced changes in the later stages, when transaminases levels returned to normal. The results indicated viral persistence in the liver and continual liver cell damage three months after YF onset and reinforced the need for extended follow-ups of YF patients. Further studies to investigate the role of possible viral persistence and the immune response causing relapsing hepatitis following YF are also necessary.