Acute liver failure in an Immunocompetent host:A Diagnostic Dilemma
Keywords:
Acute liver failure ,cytomegalovirus hepatitis
Abstract
Acute liver failure(ALF) is defined as acute onset of hepatic dysfunction with timing of 8-28 days between onset of jaundice and hepatic encephalopathy .It is a medical emergency which needs prompt diagnosis and appropriate management with identification of the aetiological factors.
I present an interesting case of acute liver failure due to cytomegalovirus(CMV) hepatitis in an immunocompetent, non addict patient without any co morbidities .The patient recovered with supportive treatment and did not require anti viral therapy as he was not immune compromised.
The importance of the case lies in the fact that viral hepatitis by CMV can present in immune competent patients also and other treatable causes of acute liver failure should also be identified as several patients of ALF may need liver transplantation.
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References
1.Sleisenger and Fordtran’s Gastrointestinal and Liver disease PATHOPHYSIOLOGY, DIAGNOSIS AND MANAGEMENT ,11TH Edition,2020.pg 1499.
2. Singh, N., Winston, D. J., Razonable, R. R., Lyon, G. M., Silveira, F. P., Wagener, M. M., et al. (2020). Effect of Preemptive Therapy vs Antiviral Prophylaxis on Cytomegalovirus Disease in Seronegative Liver Transplant Recipients With Seropositive Donors: A Randomized Clinical Trial. JAMA 323, 1378–1387. doi: 10.1001/jama.2020.3138
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6. J.H. Ko, K.R. Peck, W.J. Lee, et al.
Clinical presentation and risk factors for cytomegalovirus colitis in immunocompetent adult patients
Clin Infect Dis, 60 (2015), Article e20, 10.1093/cid/ciu969
7. M.C. Jordan, W.E. Rousseau, G.R. Noble, et al.
Association of cervical cytomegaloviruses with venereal disease
N Engl J Med, 288 (1973), p. 932, 10.1056/NEJM197305032881803
8. M.D. Tolpin, J.A. Stewart, D. Warren, et al.
Transfusion transmission of cytomegalovirus confirmed by restriction endonuclease analysis
J Pediatr, 107 (1985), p. 953, 10.1016/s0022-3476(85)80201-8
9. .M. Prince, W. Szmuness, S.J. Millian, D.S. David
A serologic study of cytomegalovirus infections associated with blood transfusions
N Engl J Med, 284 (1971), p. 1125, 10.1056/NEJ197105202842004
10.Qingluan Yang et al; Latent Cytomegalovirus Reactivation in Patients With Liver Failure: A 10-Year Retrospective Case-Control Study, 2011-2020:Frontiers in Infection and Cellular Microbiology,Vol 11,10th May,2021, https://doi.org/10.3389/fcimb.2021.642500
1.Sleisenger and Fordtran’s Gastrointestinal and Liver disease PATHOPHYSIOLOGY, DIAGNOSIS AND MANAGEMENT ,11TH Edition,2020.pg 1499.
2. Singh, N., Winston, D. J., Razonable, R. R., Lyon, G. M., Silveira, F. P., Wagener, M. M., et al. (2020). Effect of Preemptive Therapy vs Antiviral Prophylaxis on Cytomegalovirus Disease in Seronegative Liver Transplant Recipients With Seropositive Donors: A Randomized Clinical Trial. JAMA 323, 1378–1387. doi: 10.1001/jama.2020.3138
PubMed Abstract | CrossRef Full Text | Google Scholar
3. Lamb SG, Stern H: Cytomegalovirus mononucleosis with jaundice as presenting sign. Lancet. 1966, 2:1003-1006. 10.1016/s0140-6736(66)92929-1
4. Kano Y, Shiohara T: Current understanding of cytomegalovirus infection in immunocompetent individuals. J Dermatol Sci. 2000, 22:196-204. 10.1016/s0923-1811(99)00085-7
5. Shusterman NH, Frauenhoffer C, Kinsey MD: Fatal massive hepatic necrosis in cytomegalovirus mononucleosis. Ann Intern Med. 1978, 88:810-812. 10.7326/0003-4819-88-6-810
6. J.H. Ko, K.R. Peck, W.J. Lee, et al.
Clinical presentation and risk factors for cytomegalovirus colitis in immunocompetent adult patients
Clin Infect Dis, 60 (2015), Article e20, 10.1093/cid/ciu969
7. M.C. Jordan, W.E. Rousseau, G.R. Noble, et al.
Association of cervical cytomegaloviruses with venereal disease
N Engl J Med, 288 (1973), p. 932, 10.1056/NEJM197305032881803
8. M.D. Tolpin, J.A. Stewart, D. Warren, et al.
Transfusion transmission of cytomegalovirus confirmed by restriction endonuclease analysis
J Pediatr, 107 (1985), p. 953, 10.1016/s0022-3476(85)80201-8
9. .M. Prince, W. Szmuness, S.J. Millian, D.S. David
A serologic study of cytomegalovirus infections associated with blood transfusions
N Engl J Med, 284 (1971), p. 1125, 10.1056/NEJ197105202842004
10.Qingluan Yang et al; Latent Cytomegalovirus Reactivation in Patients With Liver Failure: A 10-Year Retrospective Case-Control Study, 2011-2020:Frontiers in Infection and Cellular Microbiology,Vol 11,10th May,2021, https://doi.org/10.3389/fcimb.2021.642500
1.Sleisenger and Fordtran’s Gastrointestinal and Liver disease PATHOPHYSIOLOGY, DIAGNOSIS AND MANAGEMENT ,11TH Edition,2020.pg 1499.
2. Singh, N., Winston, D. J., Razonable, R. R., Lyon, G. M., Silveira, F. P., Wagener, M. M., et al. (2020). Effect of Preemptive Therapy vs Antiviral Prophylaxis on Cytomegalovirus Disease in Seronegative Liver Transplant Recipients With Seropositive Donors: A Randomized Clinical Trial. JAMA 323, 1378–1387. doi: 10.1001/jama.2020.3138
PubMed Abstract | CrossRef Full Text | Google Scholar
3. Lamb SG, Stern H: Cytomegalovirus mononucleosis with jaundice as presenting sign. Lancet. 1966, 2:1003-1006. 10.1016/s0140-6736(66)92929-1
4. Kano Y, Shiohara T: Current understanding of cytomegalovirus infection in immunocompetent individuals. J Dermatol Sci. 2000, 22:196-204. 10.1016/s0923-1811(99)00085-7
5. Shusterman NH, Frauenhoffer C, Kinsey MD: Fatal massive hepatic necrosis in cytomegalovirus mononucleosis. Ann Intern Med. 1978, 88:810-812. 10.7326/0003-4819-88-6-810
6. J.H. Ko, K.R. Peck, W.J. Lee, et al.
Clinical presentation and risk factors for cytomegalovirus colitis in immunocompetent adult patients
Clin Infect Dis, 60 (2015), Article e20, 10.1093/cid/ciu969
7. M.C. Jordan, W.E. Rousseau, G.R. Noble, et al.
Association of cervical cytomegaloviruses with venereal disease
N Engl J Med, 288 (1973), p. 932, 10.1056/NEJM197305032881803
8. M.D. Tolpin, J.A. Stewart, D. Warren, et al.
Transfusion transmission of cytomegalovirus confirmed by restriction endonuclease analysis
J Pediatr, 107 (1985), p. 953, 10.1016/s0022-3476(85)80201-8
9. .M. Prince, W. Szmuness, S.J. Millian, D.S. David
A serologic study of cytomegalovirus infections associated with blood transfusions
N Engl J Med, 284 (1971), p. 1125, 10.1056/NEJ197105202842004
10.Qingluan Yang et al; Latent Cytomegalovirus Reactivation in Patients With Liver Failure: A 10-Year Retrospective Case-Control Study, 2011-2020:Frontiers in Infection and Cellular Microbiology,Vol 11,10th May,2021, https://doi.org/10.3389/fcimb.2021.642500
1.Sleisenger and Fordtran’s Gastrointestinal and Liver disease PATHOPHYSIOLOGY, DIAGNOSIS AND MANAGEMENT ,11TH Edition,2020.pg 1499.
2. Singh, N., Winston, D. J., Razonable, R. R., Lyon, G. M., Silveira, F. P., Wagener, M. M., et al. (2020). Effect of Preemptive Therapy vs Antiviral Prophylaxis on Cytomegalovirus Disease in Seronegative Liver Transplant Recipients With Seropositive Donors: A Randomized Clinical Trial. JAMA 323, 1378–1387. doi: 10.1001/jama.2020.3138
PubMed Abstract | CrossRef Full Text | Google Scholar
3. Lamb SG, Stern H: Cytomegalovirus mononucleosis with jaundice as presenting sign. Lancet. 1966, 2:1003-1006. 10.1016/s0140-6736(66)92929-1
4. Kano Y, Shiohara T: Current understanding of cytomegalovirus infection in immunocompetent individuals. J Dermatol Sci. 2000, 22:196-204. 10.1016/s0923-1811(99)00085-7
5. Shusterman NH, Frauenhoffer C, Kinsey MD: Fatal massive hepatic necrosis in cytomegalovirus mononucleosis. Ann Intern Med. 1978, 88:810-812. 10.7326/0003-4819-88-6-810
6. J.H. Ko, K.R. Peck, W.J. Lee, et al.
Clinical presentation and risk factors for cytomegalovirus colitis in immunocompetent adult patients
Clin Infect Dis, 60 (2015), Article e20, 10.1093/cid/ciu969
7. M.C. Jordan, W.E. Rousseau, G.R. Noble, et al.
Association of cervical cytomegaloviruses with venereal disease
N Engl J Med, 288 (1973), p. 932, 10.1056/NEJM197305032881803
8. M.D. Tolpin, J.A. Stewart, D. Warren, et al.
Transfusion transmission of cytomegalovirus confirmed by restriction endonuclease analysis
J Pediatr, 107 (1985), p. 953, 10.1016/s0022-3476(85)80201-8
9. .M. Prince, W. Szmuness, S.J. Millian, D.S. David
A serologic study of cytomegalovirus infections associated with blood transfusions
N Engl J Med, 284 (1971), p. 1125, 10.1056/NEJ197105202842004
10.Qingluan Yang et al; Latent Cytomegalovirus Reactivation in Patients With Liver Failure: A 10-Year Retrospective Case-Control Study, 2011-2020:Frontiers in Infection and Cellular Microbiology,Vol 11,10th May,2021, https://doi.org/10.3389/fcimb.2021.642500
1.Sleisenger and Fordtran’s Gastrointestinal and Liver disease PATHOPHYSIOLOGY, DIAGNOSIS AND MANAGEMENT ,11TH Edition,2020.pg 1499.
2. Singh, N., Winston, D. J., Razonable, R. R., Lyon, G. M., Silveira, F. P., Wagener, M. M., et al. (2020). Effect of Preemptive Therapy vs Antiviral Prophylaxis on Cytomegalovirus Disease in Seronegative Liver Transplant Recipients With Seropositive Donors: A Randomized Clinical Trial. JAMA 323, 1378–1387. doi: 10.1001/jama.2020.3138
PubMed Abstract | CrossRef Full Text | Google Scholar
3. Lamb SG, Stern H: Cytomegalovirus mononucleosis with jaundice as presenting sign. Lancet. 1966, 2:1003-1006. 10.1016/s0140-6736(66)92929-1
4. Kano Y, Shiohara T: Current understanding of cytomegalovirus infection in immunocompetent individuals. J Dermatol Sci. 2000, 22:196-204. 10.1016/s0923-1811(99)00085-7
5. Shusterman NH, Frauenhoffer C, Kinsey MD: Fatal massive hepatic necrosis in cytomegalovirus mononucleosis. Ann Intern Med. 1978, 88:810-812. 10.7326/0003-4819-88-6-810
6. J.H. Ko, K.R. Peck, W.J. Lee, et al.
Clinical presentation and risk factors for cytomegalovirus colitis in immunocompetent adult patients
Clin Infect Dis, 60 (2015), Article e20, 10.1093/cid/ciu969
7. M.C. Jordan, W.E. Rousseau, G.R. Noble, et al.
Association of cervical cytomegaloviruses with venereal disease
N Engl J Med, 288 (1973), p. 932, 10.1056/NEJM197305032881803
8. M.D. Tolpin, J.A. Stewart, D. Warren, et al.
Transfusion transmission of cytomegalovirus confirmed by restriction endonuclease analysis
J Pediatr, 107 (1985), p. 953, 10.1016/s0022-3476(85)80201-8
9. .M. Prince, W. Szmuness, S.J. Millian, D.S. David
A serologic study of cytomegalovirus infections associated with blood transfusions
N Engl J Med, 284 (1971), p. 1125, 10.1056/NEJ197105202842004
10.Qingluan Yang et al; Latent Cytomegalovirus Reactivation in Patients With Liver Failure: A 10-Year Retrospective Case-Control Study, 2011-2020:Frontiers in Infection and Cellular Microbiology,Vol 11,10th May,2021, https://doi.org/10.3389/fcimb.2021.642500
2. Singh, N., Winston, D. J., Razonable, R. R., Lyon, G. M., Silveira, F. P., Wagener, M. M., et al. (2020). Effect of Preemptive Therapy vs Antiviral Prophylaxis on Cytomegalovirus Disease in Seronegative Liver Transplant Recipients With Seropositive Donors: A Randomized Clinical Trial. JAMA 323, 1378–1387. doi: 10.1001/jama.2020.3138
PubMed Abstract | CrossRef Full Text | Google Scholar
3. Lamb SG, Stern H: Cytomegalovirus mononucleosis with jaundice as presenting sign. Lancet. 1966, 2:1003-1006. 10.1016/s0140-6736(66)92929-1
4. Kano Y, Shiohara T: Current understanding of cytomegalovirus infection in immunocompetent individuals. J Dermatol Sci. 2000, 22:196-204. 10.1016/s0923-1811(99)00085-7
5. Shusterman NH, Frauenhoffer C, Kinsey MD: Fatal massive hepatic necrosis in cytomegalovirus mononucleosis. Ann Intern Med. 1978, 88:810-812. 10.7326/0003-4819-88-6-810
6. J.H. Ko, K.R. Peck, W.J. Lee, et al.
Clinical presentation and risk factors for cytomegalovirus colitis in immunocompetent adult patients
Clin Infect Dis, 60 (2015), Article e20, 10.1093/cid/ciu969
7. M.C. Jordan, W.E. Rousseau, G.R. Noble, et al.
Association of cervical cytomegaloviruses with venereal disease
N Engl J Med, 288 (1973), p. 932, 10.1056/NEJM197305032881803
8. M.D. Tolpin, J.A. Stewart, D. Warren, et al.
Transfusion transmission of cytomegalovirus confirmed by restriction endonuclease analysis
J Pediatr, 107 (1985), p. 953, 10.1016/s0022-3476(85)80201-8
9. .M. Prince, W. Szmuness, S.J. Millian, D.S. David
A serologic study of cytomegalovirus infections associated with blood transfusions
N Engl J Med, 284 (1971), p. 1125, 10.1056/NEJ197105202842004
10.Qingluan Yang et al; Latent Cytomegalovirus Reactivation in Patients With Liver Failure: A 10-Year Retrospective Case-Control Study, 2011-2020:Frontiers in Infection and Cellular Microbiology,Vol 11,10th May,2021, https://doi.org/10.3389/fcimb.2021.642500
1.Sleisenger and Fordtran’s Gastrointestinal and Liver disease PATHOPHYSIOLOGY, DIAGNOSIS AND MANAGEMENT ,11TH Edition,2020.pg 1499.
2. Singh, N., Winston, D. J., Razonable, R. R., Lyon, G. M., Silveira, F. P., Wagener, M. M., et al. (2020). Effect of Preemptive Therapy vs Antiviral Prophylaxis on Cytomegalovirus Disease in Seronegative Liver Transplant Recipients With Seropositive Donors: A Randomized Clinical Trial. JAMA 323, 1378–1387. doi: 10.1001/jama.2020.3138
PubMed Abstract | CrossRef Full Text | Google Scholar
3. Lamb SG, Stern H: Cytomegalovirus mononucleosis with jaundice as presenting sign. Lancet. 1966, 2:1003-1006. 10.1016/s0140-6736(66)92929-1
4. Kano Y, Shiohara T: Current understanding of cytomegalovirus infection in immunocompetent individuals. J Dermatol Sci. 2000, 22:196-204. 10.1016/s0923-1811(99)00085-7
5. Shusterman NH, Frauenhoffer C, Kinsey MD: Fatal massive hepatic necrosis in cytomegalovirus mononucleosis. Ann Intern Med. 1978, 88:810-812. 10.7326/0003-4819-88-6-810
6. J.H. Ko, K.R. Peck, W.J. Lee, et al.
Clinical presentation and risk factors for cytomegalovirus colitis in immunocompetent adult patients
Clin Infect Dis, 60 (2015), Article e20, 10.1093/cid/ciu969
7. M.C. Jordan, W.E. Rousseau, G.R. Noble, et al.
Association of cervical cytomegaloviruses with venereal disease
N Engl J Med, 288 (1973), p. 932, 10.1056/NEJM197305032881803
8. M.D. Tolpin, J.A. Stewart, D. Warren, et al.
Transfusion transmission of cytomegalovirus confirmed by restriction endonuclease analysis
J Pediatr, 107 (1985), p. 953, 10.1016/s0022-3476(85)80201-8
9. .M. Prince, W. Szmuness, S.J. Millian, D.S. David
A serologic study of cytomegalovirus infections associated with blood transfusions
N Engl J Med, 284 (1971), p. 1125, 10.1056/NEJ197105202842004
10.Qingluan Yang et al; Latent Cytomegalovirus Reactivation in Patients With Liver Failure: A 10-Year Retrospective Case-Control Study, 2011-2020:Frontiers in Infection and Cellular Microbiology,Vol 11,10th May,2021, https://doi.org/10.3389/fcimb.2021.642500
1.Sleisenger and Fordtran’s Gastrointestinal and Liver disease PATHOPHYSIOLOGY, DIAGNOSIS AND MANAGEMENT ,11TH Edition,2020.pg 1499.
2. Singh, N., Winston, D. J., Razonable, R. R., Lyon, G. M., Silveira, F. P., Wagener, M. M., et al. (2020). Effect of Preemptive Therapy vs Antiviral Prophylaxis on Cytomegalovirus Disease in Seronegative Liver Transplant Recipients With Seropositive Donors: A Randomized Clinical Trial. JAMA 323, 1378–1387. doi: 10.1001/jama.2020.3138
PubMed Abstract | CrossRef Full Text | Google Scholar
3. Lamb SG, Stern H: Cytomegalovirus mononucleosis with jaundice as presenting sign. Lancet. 1966, 2:1003-1006. 10.1016/s0140-6736(66)92929-1
4. Kano Y, Shiohara T: Current understanding of cytomegalovirus infection in immunocompetent individuals. J Dermatol Sci. 2000, 22:196-204. 10.1016/s0923-1811(99)00085-7
5. Shusterman NH, Frauenhoffer C, Kinsey MD: Fatal massive hepatic necrosis in cytomegalovirus mononucleosis. Ann Intern Med. 1978, 88:810-812. 10.7326/0003-4819-88-6-810
6. J.H. Ko, K.R. Peck, W.J. Lee, et al.
Clinical presentation and risk factors for cytomegalovirus colitis in immunocompetent adult patients
Clin Infect Dis, 60 (2015), Article e20, 10.1093/cid/ciu969
7. M.C. Jordan, W.E. Rousseau, G.R. Noble, et al.
Association of cervical cytomegaloviruses with venereal disease
N Engl J Med, 288 (1973), p. 932, 10.1056/NEJM197305032881803
8. M.D. Tolpin, J.A. Stewart, D. Warren, et al.
Transfusion transmission of cytomegalovirus confirmed by restriction endonuclease analysis
J Pediatr, 107 (1985), p. 953, 10.1016/s0022-3476(85)80201-8
9. .M. Prince, W. Szmuness, S.J. Millian, D.S. David
A serologic study of cytomegalovirus infections associated with blood transfusions
N Engl J Med, 284 (1971), p. 1125, 10.1056/NEJ197105202842004
10.Qingluan Yang et al; Latent Cytomegalovirus Reactivation in Patients With Liver Failure: A 10-Year Retrospective Case-Control Study, 2011-2020:Frontiers in Infection and Cellular Microbiology,Vol 11,10th May,2021, https://doi.org/10.3389/fcimb.2021.642500
1.Sleisenger and Fordtran’s Gastrointestinal and Liver disease PATHOPHYSIOLOGY, DIAGNOSIS AND MANAGEMENT ,11TH Edition,2020.pg 1499.
2. Singh, N., Winston, D. J., Razonable, R. R., Lyon, G. M., Silveira, F. P., Wagener, M. M., et al. (2020). Effect of Preemptive Therapy vs Antiviral Prophylaxis on Cytomegalovirus Disease in Seronegative Liver Transplant Recipients With Seropositive Donors: A Randomized Clinical Trial. JAMA 323, 1378–1387. doi: 10.1001/jama.2020.3138
PubMed Abstract | CrossRef Full Text | Google Scholar
3. Lamb SG, Stern H: Cytomegalovirus mononucleosis with jaundice as presenting sign. Lancet. 1966, 2:1003-1006. 10.1016/s0140-6736(66)92929-1
4. Kano Y, Shiohara T: Current understanding of cytomegalovirus infection in immunocompetent individuals. J Dermatol Sci. 2000, 22:196-204. 10.1016/s0923-1811(99)00085-7
5. Shusterman NH, Frauenhoffer C, Kinsey MD: Fatal massive hepatic necrosis in cytomegalovirus mononucleosis. Ann Intern Med. 1978, 88:810-812. 10.7326/0003-4819-88-6-810
6. J.H. Ko, K.R. Peck, W.J. Lee, et al.
Clinical presentation and risk factors for cytomegalovirus colitis in immunocompetent adult patients
Clin Infect Dis, 60 (2015), Article e20, 10.1093/cid/ciu969
7. M.C. Jordan, W.E. Rousseau, G.R. Noble, et al.
Association of cervical cytomegaloviruses with venereal disease
N Engl J Med, 288 (1973), p. 932, 10.1056/NEJM197305032881803
8. M.D. Tolpin, J.A. Stewart, D. Warren, et al.
Transfusion transmission of cytomegalovirus confirmed by restriction endonuclease analysis
J Pediatr, 107 (1985), p. 953, 10.1016/s0022-3476(85)80201-8
9. .M. Prince, W. Szmuness, S.J. Millian, D.S. David
A serologic study of cytomegalovirus infections associated with blood transfusions
N Engl J Med, 284 (1971), p. 1125, 10.1056/NEJ197105202842004
10.Qingluan Yang et al; Latent Cytomegalovirus Reactivation in Patients With Liver Failure: A 10-Year Retrospective Case-Control Study, 2011-2020:Frontiers in Infection and Cellular Microbiology,Vol 11,10th May,2021, https://doi.org/10.3389/fcimb.2021.642500
1.Sleisenger and Fordtran’s Gastrointestinal and Liver disease PATHOPHYSIOLOGY, DIAGNOSIS AND MANAGEMENT ,11TH Edition,2020.pg 1499.
2. Singh, N., Winston, D. J., Razonable, R. R., Lyon, G. M., Silveira, F. P., Wagener, M. M., et al. (2020). Effect of Preemptive Therapy vs Antiviral Prophylaxis on Cytomegalovirus Disease in Seronegative Liver Transplant Recipients With Seropositive Donors: A Randomized Clinical Trial. JAMA 323, 1378–1387. doi: 10.1001/jama.2020.3138
PubMed Abstract | CrossRef Full Text | Google Scholar
3. Lamb SG, Stern H: Cytomegalovirus mononucleosis with jaundice as presenting sign. Lancet. 1966, 2:1003-1006. 10.1016/s0140-6736(66)92929-1
4. Kano Y, Shiohara T: Current understanding of cytomegalovirus infection in immunocompetent individuals. J Dermatol Sci. 2000, 22:196-204. 10.1016/s0923-1811(99)00085-7
5. Shusterman NH, Frauenhoffer C, Kinsey MD: Fatal massive hepatic necrosis in cytomegalovirus mononucleosis. Ann Intern Med. 1978, 88:810-812. 10.7326/0003-4819-88-6-810
6. J.H. Ko, K.R. Peck, W.J. Lee, et al.
Clinical presentation and risk factors for cytomegalovirus colitis in immunocompetent adult patients
Clin Infect Dis, 60 (2015), Article e20, 10.1093/cid/ciu969
7. M.C. Jordan, W.E. Rousseau, G.R. Noble, et al.
Association of cervical cytomegaloviruses with venereal disease
N Engl J Med, 288 (1973), p. 932, 10.1056/NEJM197305032881803
8. M.D. Tolpin, J.A. Stewart, D. Warren, et al.
Transfusion transmission of cytomegalovirus confirmed by restriction endonuclease analysis
J Pediatr, 107 (1985), p. 953, 10.1016/s0022-3476(85)80201-8
9. .M. Prince, W. Szmuness, S.J. Millian, D.S. David
A serologic study of cytomegalovirus infections associated with blood transfusions
N Engl J Med, 284 (1971), p. 1125, 10.1056/NEJ197105202842004
10.Qingluan Yang et al; Latent Cytomegalovirus Reactivation in Patients With Liver Failure: A 10-Year Retrospective Case-Control Study, 2011-2020:Frontiers in Infection and Cellular Microbiology,Vol 11,10th May,2021, https://doi.org/10.3389/fcimb.2021.642500
How to Cite
1.
MAITRA S. Acute liver failure in an Immunocompetent host:A Diagnostic Dilemma. Int J Med Res Rev [Internet]. 2023Jul.15 [cited 2024Nov.26];11(3):78-1. Available from: https://ijmrr.medresearch.in/index.php/ijmrr/article/view/1423
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Case Report
Copyright (c) 2023 Author (s). Published by Siddharth Health Research and Social Welfare Society
This work is licensed under a Creative Commons Attribution 4.0 International License.
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