ReviewFrontiers in immunology2026
Epstein-Barr virus and hepatic failure: pathogenesis, clinical manifestations, and management.
Review in Frontiers in immunology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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2 authors.
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Abstract
Epstein-Barr virus (EBV) infection is ubiquitous, affecting over 90% of the global population, and while typically benign, it can rarely cause acute liver failure - a life-threatening complication that is frequently fatal. This review comprehensively reviews two overlapping clinical and pathogenetic patterns of EBV-associated hepatic failure - isolated severe EBV hepatitis and EBV-triggered hemophagocytic lymphohistiocytosis (HLH) - which are best understood as ends of a clinical spectrum rather than discrete entities. In isolated EBV hepatitis, liver injury is driven by CD8-positive T cells attacking EBV-infected B cells, causing bystander hepatocyte necrosis; inflammation remains confined to the liver, and supportive care is usually sufficient. By contrast, EBV-HLH involves EBV-infected monoclonal T or natural killer cells triggering a systemic cytokine storm (including interferon-gamma, tumor necrosis factor-alpha, interleukin-6, and interleukin-18) with hemophagocytosis, requiring immediate immunosuppression. In one pediatric cohort, an EBV DNA load exceeding 100,000 copies per milliliter was associated with a more than ten-fold increase in mortality, although no universally validated cutoff has been established across age groups or sample types; T-cell EBV DNA load provides additional prognostic information. Blood purification is an experimental adjunctive strategy in refractory cases, supported by very low-certainty evidence. We also discuss risk factors, diagnostic algorithms (including EBV DNA load, HLH-2004 criteria, and histopathology), therapeutic strategies (supportive care, antiviral therapy, immunomodulation, and liver transplantation), and future research priorities. Early recognition of HLH is life-saving. This review provides a practical clinical framework for differentiating these two entities and highlights knowledge gaps for future investigation.
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