Acute Liver Failure Associated with Influenza A Virus Infection: an Autopsy Case Report

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

doi:10.7883/yoken.JJID.2018.494

Short Communications

Acute Liver Failure Associated with Influenza A Virus Infection: an Autopsy Case Report

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

Author information

Keisuke Nonaka
Department of Pathology, Tokyo Metropolitan Geriatric Hospital
Yoko Matsuda
Department of Pathology, Tokyo Metropolitan Geriatric Hospital
Mototsune Kakizaki
Department of Pathology, Tokyo Metropolitan Geriatric Hospital
Shoichiro Takakuma
Department of Pathology, Tokyo Metropolitan Geriatric Hospital
Akihiko Hamamatsu
Department of Pathology, Tokyo Metropolitan Geriatric Hospital
Yasuhiro Sakashita
Department of Neuropathology (Brain Bank for Aging Research), Research Team for Geriatric Pathology, Tokyo Metropolitan Institute of Gerontology
Tomoyasu Matsubara
Department of Neuropathology (Brain Bank for Aging Research), Research Team for Geriatric Pathology, Tokyo Metropolitan Institute of Gerontology
Shigeo Murayama
Department of Neuropathology (Brain Bank for Aging Research), Research Team for Geriatric Pathology, Tokyo Metropolitan Institute of Gerontology
Toshiyuki Ishiwata
Division of Aging and Carcinogenesis, Research Team for Geriatric Pathology, Tokyo Metropolitan Institute of Gerontology
Noriko Yamanaka
Department of Nephrology, Tokyo Metropolitan Geriatric Hospital
Mitsuyo Itabashi
Department of Nephrology, Tokyo Metropolitan Geriatric Hospital
Takashi Takei
Department of Nephrology, Tokyo Metropolitan Geriatric Hospital
Noriko Nakajima
Department of Pathology, National Institute of Infectious Diseases
Hideki Hasegawa
Department of Pathology, National Institute of Infectious Diseases
Tomio Arai
Department of Pathology, Tokyo Metropolitan Geriatric Hospital

Keywords: influenza A virus, acute liver failure, hypercytokinemia, hypoxic hepatitis

JOURNAL FREE ACCESS

2019 Volume 72 Issue 5 Pages 347-349

DOI https://doi.org/10.7883/yoken.JJID.2018.494

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Abstract

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.

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