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Gupta M, Manek G, Dombrowski K, Maiwall R. Newer developments in viral hepatitis: Looking beyond hepatotropic viruses. World J Meta-Anal 2021; 9:522-542. [DOI: 10.13105/wjma.v9.i6.522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/09/2021] [Accepted: 12/08/2021] [Indexed: 02/06/2023] Open
Abstract
Viral hepatitis in the entirety of its clinical spectrum is vast and most discussion are often restricted to hepatotropic viral infections, including hepatitis virus (A to E). With the advent of more advanced diagnostic techniques, it has now become possible to diagnose patients with non-hepatotropic viral infection in patients with hepatitis. Majority of these viruses belong to the Herpes family, with characteristic feature of latency. With the increase in the rate of liver transplantation globally, especially for the indication of acute hepatitis, it becomes even more relevant to identify non hepatotropic viral infection as the primary hepatic insult. Immunosuppression post-transplant is an established cause of reactivation of a number of viral infections that could then indirectly cause hepatic injury. Antiviral agents may be utilized for treatment of most of these infections, although data supporting their role is derived primarily from case reports. There are no current guidelines to manage patients suspected to have viral hepatitis secondary to non-hepatotropic viral infection, a gap that needs to be addressed. In this review article, the authors analyze the common non hepatotropic viral infections contributing to viral hepatitis, with emphasis on recent advances on diagnosis, management and role of liver transplantation.
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Affiliation(s)
- Manasvi Gupta
- Department of Internal Medicine, University of Connecticut, Farmington, CT 06030, United States
| | - Gaurav Manek
- Department of Pulmonology and Critical Care, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Kaitlyn Dombrowski
- Department of Internal Medicine, University of Connecticut, Farmington, CT 06030, United States
| | - Rakhi Maiwall
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi 110070, India
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Chávez SM, Poniachik JM, Urzua ÁM, Roblero JP, Cattaneo MJ, Jimenez AP, Carreño LE, Cornejo RA. Acute liver failure due to herpes simplex virus: diagnostic clues and potential role of plasmapheresis: A case report. Medicine (Baltimore) 2021; 100:e27139. [PMID: 34477166 PMCID: PMC8416005 DOI: 10.1097/md.0000000000027139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 08/03/2021] [Accepted: 08/18/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Acute liver failure (ALF) is a life-threatening condition that remains challenging for physicians despite several advances in supportive care. Etiologies vary worldwide, with herpes simplex virus (HSV) hepatitis representing less than 1% of cases. Despite its low incidence, ALF is a lethal cause of acute necrotizing hepatitis and has a high mortality. Early antiviral treatment is beneficial for survival and decreased liver transplantation necessity. However, plasmapheresis, despite its theoretical potential benefit, is scarcely reported. PATIENT CONCERNS A 25-year-old woman with no known disease presented with painful pharynx ulcers, increased transaminases and impaired liver function. DIAGNOSIS ALF due to a disseminated HSV-2 primary infection was diagnosed with a positive polymerase chain reaction for HSV-2 in the biopsied liver tissue and blood. INTERVENTIONS Empiric antiviral treatment was initiated. After clinical deterioration, plasmapheresis was also initiated. OUTCOMES After 6 cycles of plasmapheresis and supportive care, the patient's condition improved without undergoing liver transplantation. CONCLUSIONS ALF is a life-threatening condition, and HSV as an etiology must be suspected based on background, clinical manifestation, and laboratory information. The potential role of plasmapheresis in HSV hepatitis should be considered.
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Affiliation(s)
- Sebastián M. Chávez
- Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico Universidad de Chile. Santiago, Chile
| | - Jaime M. Poniachik
- Sección Gastroenterología, Departamento de Medicina, Hospital Clínico Universidad de Chile. Santiago, Chile
| | - Álvaro M. Urzua
- Sección Gastroenterología, Departamento de Medicina, Hospital Clínico Universidad de Chile. Santiago, Chile
| | - Juan P. Roblero
- Sección Gastroenterología, Departamento de Medicina, Hospital Clínico Universidad de Chile. Santiago, Chile
| | - Máximo J. Cattaneo
- Sección Gastroenterología, Departamento de Medicina, Hospital Clínico Universidad de Chile. Santiago, Chile
| | - Andrea P. Jimenez
- Sección Gastroenterología, Departamento de Medicina, Hospital Clínico Universidad de Chile. Santiago, Chile
| | - Laura E. Carreño
- Departamento de Anatomía patológica, Hospital Clínico Universidad de Chile. Santiago, Chile
| | - Rodrigo A. Cornejo
- Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico Universidad de Chile. Santiago, Chile
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Srinivasan D, Kaul CM, Buttar AB, Nottingham FI, Greene JB. Disseminated Herpes Simplex Virus-2 (HSV-2) as a Cause of Viral Hepatitis in an Immunocompetent Host. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e932474. [PMID: 34341324 PMCID: PMC8349572 DOI: 10.12659/ajcr.932474] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Patient: Male, 57-year-old Final Diagnosis: Hepatitis • herpes Symptoms: Fever Medication: — Clinical Procedure: — Specialty: General and Internal Medicine
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Affiliation(s)
- Dushyanth Srinivasan
- Division of Hospital Medicine, Department of Medicine, New York University (NYU) Grossman School of Medicine, New York City, NY, USA
| | - Christina M Kaul
- Division of Infectious Diseases and Immunology, Department of Medicine, New York University (NYU) Grossman School of Medicine, New York City, NY, USA
| | - Amna B Buttar
- Division of Geriatric Medicine, Department of Medicine, New York University (NYU) Grossman School of Medicine, New York City, NY, USA
| | - Fatima I Nottingham
- Division of Hospital Medicine, Department of Medicine, New York University (NYU) Grossman School of Medicine, New York City, NY, USA
| | - Jeffrey B Greene
- Division of Infectious Diseases and Immunology, Department of Medicine, New York University (NYU) Grossman School of Medicine, New York City, NY, USA
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Abstract
BACKGROUND Herpes simplex virus (HSV) causes only 2-4% of all acute hepatitis but has high morbidity and mortality. Pregnancy is a risk factor for HSV hepatitis. We describe a case of gestational HSV hepatitis. CASE A 32-year old woman, gravida 2 para 1, presented at 38 2/7 weeks of gestation with back pain and fetal tachycardia. She became febrile after admission, had spontaneous rupture of membranes, and was delivered by cesarean for malpresentation. Postpartum, she became persistently febrile and developed transaminitis, symptomatic hypotension, and pancytopenia despite antibiotics. Imaging revealed acute liver injury, splenomegaly, pleural effusions, and cardiomyopathy. Serum polymerase chain reaction (PCR) screening identified HSV-1 infection. The patient recovered on acyclovir. There was no evidence of neonatal seroconversion. CONCLUSION Herpes simplex virus hepatitis causes significant morbidity, and pregnant women are susceptible to severe infections. Pregnant or peripartum women with acute febrile hepatitis require prompt evaluation for HSV with serum PCR screening.
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Then EO, Gayam V, Are VS, Sunkara T, Gaduputi V. Herpes Simplex Virus Hepatitis: A Brief Review of an Oft-overlooked Pathology. Cureus 2019; 11:e4313. [PMID: 31183293 PMCID: PMC6538099 DOI: 10.7759/cureus.4313] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Herpes simplex virus (HSV) is a rarely reported cause of viral hepatitis. Aggressive in nature, most cases of HSV hepatitis rapidly progress to fulminant hepatic failure. Present day, its pathogenesis is yet to be elucidated, but its complications and associated high mortality rate are clear. Clinically, its symptoms mimic those of other causes of acute hepatic failure thus making the diagnosis of HSV hepatitis a precarious task. Although treatment in the form of acyclovir is readily available, most cases have a poor prognosis due to late initiation of therapy. This makes the early identification of HSV essential in improving outcomes and potentially preventing mortality.
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Affiliation(s)
- Eric O Then
- Internal Medicine, St. Barnabas Hospital Health System, Bronx, USA
| | - Vijay Gayam
- Internal Medicine, Interfaith Medical Center, Brooklyn, USA
| | - Vijay S Are
- Internal Medicine, Stormont Vail Health System, Lawrence, USA
| | - Tagore Sunkara
- Internal Medicine, Mercy Medical Center, Des Moines, USA
| | - Vinaya Gaduputi
- Internal Medicine, St. Barnabas Hospital Health System, Bronx, USA
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Kurosawa S, Sekiya N, Fukushima K, Ikeuchi K, Fukuda A, Takahashi H, Chen F, Hasegawa H, Katano H, Hishima T, Setoguchi K. Unusual manifestation of disseminated herpes simplex virus type 2 infection associated with pharyngotonsilitis, esophagitis, and hemophagocytic lymphohisitocytosis without genital involvement. BMC Infect Dis 2019; 19:65. [PMID: 30654754 PMCID: PMC6337778 DOI: 10.1186/s12879-019-3721-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 01/11/2019] [Indexed: 11/11/2022] Open
Abstract
Background Herpes simplex virus (HSV) has various presentations, depending on the patient’s immune status, age, and the route of transmission. In adults, HSV type 1 is found predominantly in the oral area, and HSV type 2 (HSV-2) is commonly found in the genital area. HSV-2 infection without genital lesions is uncommon. Herein we report a unique case of pharyngotonsillitis as an initial manifestation of disseminated HSV-2 infection without genital involvement. Case presentation A 46-year-old male was admitted to our hospital with a 1-week history of fever and sore throat. His past medical history included hypereosinophilic syndrome diagnosed at age 45 years. Physical examination revealed throat congestion, bilaterally enlarged tonsils with exudates, tender cervical lymphadenopathy in the left posterior triangle, and mild epigastric tenderness. The laboratory data demonstrated bicytopenia, elevated liver enzyme levels, and hyperferritinemia. A bone marrow smear showed hypocellular marrow with histiocytes and hemophagocytosis. The diagnosis of HLH was confirmed, and the patient was treated with methylprednisolone pulse therapy on days 1–3. On day 5, despite initial improvement of the fever and sore throat, multiple, new, small bullae developed on the patient’s face, trunk, and extremities. Additional testing showed that he was positive for HSV-specific immunoglobulin M and immunoglobulin G. Disseminated HSV infection was suspected, and intravenous acyclovir (10 mg/kg every 8 h) was begun. A subsequent direct antigen test of a bulla sample was positive for HSV-2. Moreover, tonsillar and esophageal biopsies revealed viral inclusion bodies. Immunohistochemical staining and a quantitative real-time polymerase chain reaction (PCR) assay confirmed the presence of HSV-2. Disseminated HSV-2 infection with multiple bullae, tonsillitis, esophagitis, and suspected hepatic involvement was diagnosed. After a 2-week course of intravenous acyclovir, his hematological status and liver function normalized, and his cutaneous skin lesions resolved. He was discharged on day 22 in good general health and continued taking oral valacyclovir for viral suppression due to his immunosuppressed status. Conclusion Disseminated HSV-2 infection should be considered as one of the differential diagnoses in patients with pharyngotonsillitis and impaired liver function of unknown etiology even if there are no genital lesions.
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Affiliation(s)
- Shuhei Kurosawa
- Division of Hematology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Hon-komagome, Tokyo, 1138677, Bunkyo-ku, Japan
| | - Noritaka Sekiya
- Department of Infection Prevention and Control, Department of Clinical Laboratory, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Hon-komagome, Tokyo, 1138677, Bunkyo-ku, Japan.
| | - Kazuaki Fukushima
- Department of Infectious Diseases, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Hon-komagome, Tokyo, 1138677, Bunkyo-ku, Japan
| | - Kazuhiko Ikeuchi
- Department of Infection Prevention and Control, Department of Clinical Laboratory, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Hon-komagome, Tokyo, 1138677, Bunkyo-ku, Japan
| | - Akito Fukuda
- Division of Rheumatology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Hon-komagome, Tokyo, 1138677, Bunkyo-ku, Japan
| | - Hideyuki Takahashi
- Division of Rheumatology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Hon-komagome, Tokyo, 1138677, Bunkyo-ku, Japan
| | - Fangyi Chen
- Division of Rheumatology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Hon-komagome, Tokyo, 1138677, Bunkyo-ku, Japan
| | - Hideki Hasegawa
- Department of Pathology, National Institute of Infectious Diseases, 1-23-1 Toyama, Tokyo, 1628640, Shinjyuku-ku, Japan
| | - Harutaka Katano
- Department of Pathology, National Institute of Infectious Diseases, 1-23-1 Toyama, Tokyo, 1628640, Shinjyuku-ku, Japan
| | - Tsunekazu Hishima
- Department of Pathology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Hon-komagome, Tokyo, 1138677, Bunkyo-ku, Japan
| | - Keigo Setoguchi
- Division of Rheumatology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Hon-komagome, Tokyo, 1138677, Bunkyo-ku, Japan
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Yokoi Y, Kaneko T, Sawayanagi T, Takano Y, Watahiki Y. Fatal fulminant herpes simplex hepatitis following surgery in an adult. World J Clin Cases 2018; 6:11-19. [PMID: 29468167 PMCID: PMC5807890 DOI: 10.12998/wjcc.v6.i2.11] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 12/15/2017] [Accepted: 01/16/2018] [Indexed: 02/05/2023] Open
Abstract
We present a case of a healthy 72-year-old man with herpes simplex hepatitis (HSVH) development soon after ordinary surgery for biliary stones. A sudden onset of hepatitis associated with high fever and leukopenia emerged on postoperative day 5, followed by a rapid and lethal course (died on day 9), despite an acyclovir therapy on day 8. Postmortem liver biopsy revealed positive immunostaining for herpes simplex virus (HSV) type-1. The serum tests (available after the death) were negative for anti-HSV immunogloblulins, but positive for HSV DNA. A review of 15 cases of postsurgical HSVH along with 42 cases of non-surgical HSH showed that (1): A wide spectrum of surgical procedures was involved; and (2): High mortality (87%) associated with lower rates of ante-mortem diagnosis (20%) and acyclovir treatment (20%). Due to the difficulty in diagnosis and lethal nature, an early clinical suspension and prompt empirical anti-viral intervention are imperative for postsurgical hepatitis with undetermined etiology, characterized by fever and leucopenia.
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Affiliation(s)
- Yoshihiro Yokoi
- Youichi Watahiki, Department of Surgery, Shinshiro Municipal Hospital, Shinshiro 441-1387, Japan
| | - Takeshi Kaneko
- Youichi Watahiki, Department of Surgery, Shinshiro Municipal Hospital, Shinshiro 441-1387, Japan
| | - Tomoki Sawayanagi
- Youichi Watahiki, Department of Surgery, Shinshiro Municipal Hospital, Shinshiro 441-1387, Japan
| | - Yasuo Takano
- Department of Pathology, Shinshiro Municipal Hospital, Shinshiro 441-1387, Japan
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Herpes Simplex Virus Hepatitis: A Presentation of Multi-Institutional Cases to Promote Early Diagnosis and Management of the Disease. Case Reports Hepatol 2017; 2017:3180984. [PMID: 28835860 PMCID: PMC5556611 DOI: 10.1155/2017/3180984] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 07/02/2017] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To compare three cases of Herpes simplex virus (HSV) hepatitis to increase early diagnosis of the disease. Case 1. A 23-year-old man with Crohn's disease and oral HSV. HSV hepatitis was diagnosed clinically and he improved with acyclovir. Case 2. An 18-year-old G1P0 woman with transaminitis. Despite early empiric acyclovir therapy, she died due to fulminant liver failure. Case 3. A 65-year-old woman who developed transaminitis after liver transplant. Diagnosis was confirmed by biopsy and she had resolution of acute liver failure with acyclovir. CONCLUSION It is imperative that clinicians be aware of patients at high risk for developing HSV hepatitis to increase timely diagnosis and prevent morbidity and fatality.
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Honsig C, Beinhardt S, Tomasits J, Dienes HP. Haemophagocytic lymphohistiocytosis associated with fulminant hepatitis and multiorgan failure following primary Epstein-Barr virus and herpes simplex virus type 1 infection. BMJ Case Rep 2017; 2017:bcr-2016-218310. [PMID: 28356254 PMCID: PMC5372189 DOI: 10.1136/bcr-2016-218310] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
We present a case of severe fatal hepatitis in a young patient presumably triggered by two ubiquitous viral diseases which occurred in close succession. This case is unusual because of the exceptional chronological sequence of primary Epstein–Barr virus and herpes simplex virus type 1 infection causing systemic immune dysregulation associated with rapidly developing liver failure and consecutive multiorgan failure. Clinical, laboratory and histopathological findings indicated the development of secondary haemophagocytic lymphohistiocytosis triggered by these closely succeeding viral primary infections.
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Affiliation(s)
- Claudia Honsig
- Division of Clinical Virology, Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Sandra Beinhardt
- Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | | | - Hans Peter Dienes
- Medical University of Vienna, Institute of Clinical Pathology, Vienna, Austria
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Recombinant herpes simplex virus type 1 strains with targeted mutations relevant for aciclovir susceptibility. Sci Rep 2016; 6:29903. [PMID: 27426251 PMCID: PMC4947914 DOI: 10.1038/srep29903] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 06/23/2016] [Indexed: 12/13/2022] Open
Abstract
Here, we describe a novel reliable method to assess the significance of individual mutations within the thymidine kinase (TK) gene of herpes simplex virus type 1 (HSV-1) to nucleoside analogue resistance. Eleven defined single nucleotide polymorphisms that occur in the TK gene of clinical HSV-1 isolates and a fluorescence reporter were introduced into the HSV-1 strain 17+ that had been cloned into a bacterial artificial chromosome. The susceptibility of these different strains to aciclovir, penciclovir, brivudin, and foscarnet was determined with a modified cytopathic effect reduction assay. The strains were also tested for their aciclovir susceptibility by measuring the relative fluorescence intensity as an indicator for HSV-1 replication and by quantifying the virus yield. Our data indicate that the amino acid substitutions R41H, R106H, A118V, L139V, K219T, S276R, L298R, S345P, and V348I represent natural polymorphisms of the TK protein, whereas G61A and P84L mediate broad cross-resistance against aciclovir, penciclovir, brivudin, and susceptibility to foscarnet. This method allows the definition of the resistance genotype of otherwise unclear mutations in the TK gene of HSV-1. Thus, it provides a scientific basis for antiviral testing in clinical isolates of patients suffering from serious diseases and will facilitate testing of new antivirals against HSV-1.
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The Honolulu Liver Disease Cluster at the Medical Center: Its Mysteries and Challenges. Int J Mol Sci 2016; 17:476. [PMID: 27043544 PMCID: PMC4848932 DOI: 10.3390/ijms17040476] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Revised: 03/18/2016] [Accepted: 03/21/2016] [Indexed: 12/16/2022] Open
Abstract
In 2013, physicians at the Honolulu Queen’s Medical Center (QMC) noticed that seven liver disease patients reported the use of OxyELITE Pro (OEP), a widely consumed dietary supplement (DS). Assuming a temporal association between OEP use and disease, they argued that OEP was the cause of this mysterious cluster. Subsequent reexamination, however, has revealed that this QMC cohort is heterogeneous and not a cluster with a single agent causing a single disease. It is heterogeneous because patients used multiple DS’s and drugs and because patients appeared to have suffered from multiple liver diseases: liver cirrhosis, liver failure by acetaminophen, hepatotoxicity by non-steroidal antiinflammatory drugs (NSAIDs), resolving acute viral hepatitis by hepatitis B virus (HBV), herpes simplex virus (HSV), and varicella zoster virus (VZV), and suspected hepatitis E virus (HEV). Failing to exclude these confounders and to consider more viable diagnoses, the QMC physicians may have missed specific treatment options in some of their patients. The QMC physicians unjustifiably upgraded their Roussel Uclaf Causality Assessment Method (RUCAM) causality scores so that all patients would appear to be “probable” for OEP. However, subsequent RUCAM reassessments by our group demonstrated a lack of causality for OEP in the evaluated QMC cases. The QMC’s questionable approaches explain the extraordinary accumulation of suspected OEP cases at the QMC in Hawaii as single place, whereas similar cohorts were not published by any larger US liver center, substantiating that the problem is with the QMC. In this review article, we present and discuss new case data and critically evaluate upcoming developments of problematic regulatory assessments by the US Centers for Disease Control and Prevention (CDC), the Hawaii Department of Health (HDOH), and the Food and Drug Administration (FDA), as based on invalid QMC conclusions, clarifying now also basic facts and facilitating constructive discussions.
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