Korean J Hepatol.  1998 Dec;4(4):305-316.

Exacerbated Hepatitis Accompanied by Myositis in Patients with Chronic Liver Disease -Suggestion of Coxsackievirus B as a Causative Agent

• Kim DG
• Lee JK
• Lee EH

Abstract

OBJECTIVES
Our aims of this study is to analyze the clinical characteristics and the prognos is of the disease which develops in patient swith chronic liver disease as acutely exacerbated hepat it is accompanied by myosit is. Finally we try to identify and is olate the causative agent.
METHODS
The patient swith chronic liver diseases, who developed muscle weakness and paralysis, were classified to group A or group B, according to the level of creatinine kinase ( CK) activity. The group A consists of patients with less than 3-fold increase of normal CK activity and the group B includes patients with over 3-fold increase of it. We evaluated clinical characteristics, blood chemistry, clinical course, and causes of deathin patients of study groups, compared with those of patients with chronic liver disease with normal CK activity as controls. The causative agent was suggested by conventional culture and RT-PCR analysis in two cases of group B.
RESULTS
1. There was no significant differences in age, sex, underlying disease, or liver function test bet ween control and study group ( control and group A or B) before entry. 2. The clinical symptoms and signs , such as drowsy mental state, generalized weakness/myalgia caused by hepatic encephalopathy and myositis , occurred frequently in the study group. 3. Significant elevation of aspartic acid transaminase (AST ) and alaninetr ans aminase ( ALT ) was noted in Group B. AST / ALT ratio is over 2 in group A or B. Synthetic function of the liver such as prothrombin time ( PT ) or serum albumin level is significantly decreased. Blood urea nitrogen ( BUN) and creatinine were increased as a result of impaired renal function. 4. Culture of coxs ackievirus was positive by immunofluor escence as say IFA) as a caus ative agent and also was positive in reverse transcription-polymerase chain reaction (RT-PCR) analys is using universal primer of enterovirus in two recent cases of group B. 5. Death rate increased significantly in study group, compared with that of control group ( 20.7% versus 5.6%). Major cause of death, 12 patients died of which, is hepatic failure.
CONCLUSION
The patients with chronic liver disease abruptly developed a exacerbated hepaticdys function and muscle paralysis and/or weakness. This exacerbated hepatitis accompanied by myositis was suggested to be caused by coxsackie B viral infection. Furthermore, this infection increase deathrate and resulted in poor prognosis. Thus, further study should be continue to confirm the causative agent and classify the subtype.

Keyword

Coxsackievirus B; Acute hepatitis and/or myositis; Poor prognosis

MeSH Terms

Aspartic Acid
Blood Urea Nitrogen
Cause of Death
Chemistry, Clinical
Creatinine
Enterovirus
Hepatic Encephalopathy
Hepatitis*
Humans
Liver Diseases*
Liver Failure
Liver Function Tests
Liver*
Mortality
Muscle Weakness
Myositis*
Paralysis
Phosphotransferases
Prognosis
Prothrombin Time
Serum Albumin
Aspartic Acid
Creatinine
Phosphotransferases
Serum Albumin