- 著者
- Keisuke Nonaka Yoko Matsuda Mototsune Kakizaki Shoichiro Takakuma Akihiko Hamamatsu Yasuhiro Sakashita Tomoyasu Matsubara Shigeo Murayama Toshiyuki Ishiwata Noriko Yamanaka Mitsuyo Itabashi Takashi Takei Noriko Nakajima Hideki Hasegawa Tomio Arai
- 出版者
- National Institute of Infectious Diseases
- 雑誌
- Japanese Journal of Infectious Diseases (ISSN:13446304)
- 巻号頁・発行日
- vol.72, no.5, pp.347-349, 2019 (Released:2019-09-19)
- 参考文献数
- 10
- 被引用文献数
- 7 7
An 84-year-old man with chronic renal failure, anemia, and diabetes was admitted for hemodialysis initiation. His vital signs were stable until the eighteenth hospital day, before acquiring an influenza A virus infection. Three days later, he died of septic shock with severe liver impairment. His leukocyte count, prothrombin time (PT-INR), and liver enzyme levels such as aspartate transaminase and alanine aminotransferase, were significantly increased. Hypercytokinemia was also observed. Autopsy revealed bilateral diffuse pneumonia with neutrophil infiltration. The liver showed extensive centrilobular hepatocyte necrosis. Immunohistochemistry for influenza A nucleoprotein revealed positivity in the ciliated columnar epithelium of the bronchi and negativity in the trachea, lungs, and liver. Hypoxic hepatitis is characterized by an abrupt and massive increase in aminotransferase levels (> 20 times upper normal limit) due to anoxic centrilobular hepatocyte necrosis. The occurrence of hypoxic hepatitis requires a pre-existing, chronic condition, such as anemia, causing reduced oxygen supply to the liver, followed by an acute decrease in hepatic oxygen supply, such as septic shock. Therefore, this report suggests that hypoxic hepatitis can be an important causative factor for acute liver failure associated with influenza virus infection.