We report two cases of fatal hepatic failure in patients who received matched unrelated bone marrow transplantation. Both patients presented with high fevers, abnormal liver functions tests, and hypodense lesions in the liver by CT scan. Histologic examination of postmortem liver samples demonstrated extensive necrosis, and immunohistochemistry was positive for adenovirus. 1. Introduction Adenovirus infections have become more prevalent in immunocompromised patients [1, 2]. However, the lack of rapid diagnostic tests for adenovirus often delays prompt diagnosis that contributes to the morbidity and mortality in this patient population. We report two cases of fatal hepatic failure in patients who received matched unrelated bone marrow transplantation for hematologic malignancies. Adenovirus commonly causes respiratory, gastrointestinal, and genitourinary disease, but fulminant hepatic failure is rare [3]. Both patients presented with high fevers, abnormal LFTs, and hypodense lesions in the liver by computed tomography (CT) scan approximately 60–120 days after bone marrow transplantation. Despite maximum supportive care, both patients died despite in one case treatment with intravenous ribavirin. Histologic examination of post-mortem liver samples from both patients demonstrated extensive necrosis and immunohistochemistry was positive for adenovirus. Moreover, adenovirus was cultured from blood and liver. Adenovirus from these two patients was serotypes 2 and 5. Risk factors for the development of this type of infection include the presence of graft versus host disease and the use of immunosuppressive agents. 2. Cases Patient 1 was a 46-year-old male who initially presented with fatigue, headache, and easy bruising. Complete blood count (CBC) showed 221,000 white blood count (WBC) with 92% blasts, hematocrit (Hct) 22%, and platelets 46,000. He was diagnosed with acute lymphoblastic leukemia (ALL with t4:11). He was treated with hydrea and allopurinol, then daunorubicin, vincristine, cyclophosphamide, prednisone and intrathecal methotrexate. He developed fever and neutropenia and subsequent blood cultures grew Streptococcus group G, treated with vancomycin and ceftazidime and recovered. He underwent T cell-depleted allogeneic bone marrow transplantation 3 months later. His post-bone marrow transplantation course was complicated with fever and neutropenia, and blood cultures grew 1/2 bottles coagulase-negative Staphylococcus spp. He was treated with Vancomycin. He subsequently developed skin graft versus host disease (GVHD) that required treatment with
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