Adenovirus can occasionally cause a clinical hepatitis, which can follow a fulminant course.
Diagnosis:
(1) hepatitis with or without mass-like lesions
(2) evidence of adenovirus infection (see below)
(3) exclusion of other causes of hepatitis (drugs, virus, Wilson disease, etc)
Evidence of adenovirus may include:
(1) adenoviral infection documented elsewhere (pneumonia, esophagitis, enterocolitis,etc)
(2) nuclear inclusions and smudge cells in a liver biopsy, positive on immunohistochemistry for adenovirus
(3) positive serology
(4) outbreak in the community
(5) positive PCR
Patients at risk for fulminant hepatitis:
(1) transplant recipient
(2) chemotherapy for malignancy
(3) other immunosuppression
(4) immunodeficiency, including HIV
