CD8(+) T-lymphocyte infiltration and apoptosis in fulminant Epstein-Barr virus hepatitis in a previously healthy girl

A previously healthy 9-month old girl presented with fulminant hepatitis ca used by the Epstein-Barr virus ( EBV). The patient developed fever, coma, a nd jaundice, and laboratory examination demonstrated acute liver failure. S he did not respond sufficiently to conservative treatment and underwent liv er transplantation with a graft from her father. Her condition improved tra nsiently, but she died several weeks after surgery from a recurrence of liv er failure. Histologic examination of the excised liver revealed massive pa nacinar necrosis and infiltration of mononuclear cells. Immunohistochemical staining identified these cells as CD8(+) T-lymphocytes. A small number of apoptotic cells were observed, the nuclei of which were clearly labeled by terminal-deoxyribosyl -transferase-mediated deoxyuridine nick-end labeling . Tests for anti-EBV antibodies gave negative results, and EBV infection wa s diagnosed by in situ hybridization of liver tissue. CD8(+) T-lymphocytes induced by the viral infection and apoptosis may have played an important r ole in damaging the hepatocytes of this patient.