Extensive necrosis is seen in this case of ADV necrotizing hepatitis.
Hepatocytes demonstrate ballooning degeneration and Councilman bodies (pink globules) indicating cell injury.
Hemosiderin deposition is very prominent.
Adenoviruses (ADV) are non-enveloped DNA viruses that generally cause mild respiratory illness. Depending on the serotype, adenoviruses can also cause conjunctivitis, gastroenteritis and hemorrhagic cystitis. ADV infections affect more children than adults and in immunocompetent children, they are self-limited infections and are of little clinical concern.
In immunosuppressed patients, however, ADV can cause fulminant systemic disease with mortality rates up to 70%. CMV, EBV and ADV represent the most important viral agents causing serious infection in pediatric patients after a solid organ transplant.1
Opportunistic infection most often encountered in the pediatric transplant population -- causes liver cell necrosis and sometimes microabscesses resembling CMV infection.
Immunosuppression may need to be reduced with co-administration of cidofovir for ADV hepatitis (Engelmann).
1 Engelmann G, Hemi A, Greil J. Adenovirus infection and treatment with cidofovir in children after liver transplantation. Pediatr Transplantation 2009:13:421-428.