A CASE OF SYNCYTIAL GIANT-CELL HEPATITIS WITH FEATURES OF A PARAMYXOVIRAL INFECTION

Adult syncytial giant cell hepatitis (GCH) is an uncommon and often fu lminant form of hepatitis that may be caused by infection with a novel paramyxo-like virus. We present the case of a 69-yr-old man who prese nted with acute, community-acquired hepatitis and chronic lymphocytic leukemia. A liver biopsy showed the typical findings of panlobular syn cytial giant cell hepatitis. Electron microscopic examination demonstr ated abundant nucleocapsid-like protein material in the cytoplasm and nuclei of affected hepatocytes, These structures were similar to, but distinct from, those of known paramyxoviridae, suggesting infection wi th a novel, related virus. In situ hybridization studies with a probe directed against the measles fusion protein gene gave a positive signa l with a hepatocyte distribution. No signal was obtained with the meas les nucleocapsid protein probe, suggesting that the disease agent was genetically distinct from, but related to, the measles virus. Subseque nt liver biopsies were characterized by the gradual disappearance of t he giant cell changes and by the concomitant development of cirrhosis, This is a case of adult GCH that resolved spontaneously and led to ci rrhosis, thus implicating GCH as a potential cause of ''cryptogenic'' liver disease. Our findings provide further support for the existence of a distinct, as yet unidentified viral species as a cause of this di sease. (Am J Gastroenterol 1998; 93:1931-1937. (C) 1998 by Am. Cell. o f Gastroenterology).