Immunohistologic Identification of Epstein‐Barr Virus‐Induced Hepatitis Reactivation after OKT‐3 Therapy following Orthotopic Liver Transplant

Reactivated Epstein‐Barr virus infection associated with hepatitis appeared in a liver transplant patient receiving monoclonal OKT‐3 antibody for rejection. The histologic findings in liver biopsy specimens characteristic of allograft rejection were observed prior to and during the initial phase of antirejection therapy. However, failure of a complete response to antirejection therapy promoted rebiopsy. The specimen showed portal infiltrates composed predominantly of plasma cells and immunoblasts. The presumptive diagnosis of Ep‐stein‐Barr virus hepatitis was confirmed by staining frozen liver tissue for Epstein‐Barr virus nuclear‐associated antigen. OKT‐3 therapy was discontinued, and cycolsporine and steroid doses were reduced. Gradually, clinical features, serum aminotransferase and bilirubin levels, and the portal lymphoid infiltrate resolved. Epstein‐Barr virus serology showed an increase in convalescent titers IgG‐antiviral capsid antigen, and Epstein‐Barr virus nuclear‐associated antigen. The histologic, clinical, and laboratory features supporting the diagnosis of Epstein‐Barr virus hepatitis in a liver transplant patient are presented and discussed. This diagnosis guided appropriate therapy.