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Late-Relapsing Hepatitis after Yellow Fever

2020; Multidisciplinary Digital Publishing Institute; Volume: 12; Issue: 2 Linguagem: Inglês

10.3390/v12020222

1999-4915

Izabela Maurício de Rezende, Leonardo Soares Pereira, Jordana Rodrigues Barbosa Fradico, Marcelo Antônio Pascoal-Xavier, Pedro Augusto Alves, Ana Carolina Campi‐Azevedo, Elaine Speziali, Lívia Zignago Moreira dos Santos, Natália Soares Albuquerque, Indiara Penido, Tayrine Araújo Santos, Ana Paula Dinis Ano Bom, Andréa Marques Vieira da Silva, Camilla Bayma Fernandes, Carlos Eduardo Calzavara-Silva, Erna Geessien Kroon, Olindo Assis Martins‐Filho, Andréa Teixeira−Carvalho, Betânia Paiva Drumond,

Viral Infections and Vectors

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.