{
  "abstract": "Background: Teplizumab (anti-CD3) delays progression from stage 2 to stage 3 type 1 diabetes (T1D) but can be associated with laboratory abnormalities and virologic findings, including Epstein-Barr virus (EBV) DNAemia.\n\nMethods: We report a 15-year-old boy with stage 2 T1D who received a standard course of teplizumab and developed a biphasic rise in aminotransferases occurring mainly after the end of infusions, with preserved bilirubin and coagulation parameters.\n\nResults: During treatment, ALT/AST rose to 78/44 U/L (1.90/1.10×ULN). After completion, ALT/AST increased to 292/172 U/L (7.12/4.30×ULN) on post-treatment day +5 and peaked at 428/220 U/L (10.44/5.50×ULN) on day +6, followed by partial improvement and a second flare beginning on day +20 and peaking on day +24 (ALT 293 U/L, 7.15×ULN; AST 118 U/L, 2.95×ULN; GGT 142 U/L), with normal bilirubin. Coagulation parameters remained within the normal range. Work-up for autoimmune hepatitis, hepatitis B/C, CMV, adenovirus, parvovirus B19, and toxoplasmosis was negative. Abdominal ultrasound/Doppler was unremarkable. MRI reported liver size mildly increased/at the upper limit of normal, nonspecific segment IV abnormalities, and reactive abdominal lymph nodes, with interval improvement at follow-up. Pre-treatment VCA IgG was positive and VCA IgM negative. At post-treatment day +10, whole-blood EBV DNA was 538,623 copies/mL, with negative VCA IgM, EA IgG and EBNA IgG, decreasing to <200 copies/mL at 6 months. Liver enzymes normalized spontaneously over follow-up.\n\nConclusion: This case highlights marked, biphasic liver injury occurring after teplizumab in association with marked EBV DNAemia. The available clinical, serological, virological, and medication-timing data do not permit definitive attribution to teplizumab, EBV-related hepatic involvement, or concomitant medications. Post-treatment monitoring of both liver enzymes and EBV DNA may be helpful.",
  "abstract_shown": true,
  "affiliations": [
    "Unit of Pediatrics, San Salvatore Hospital",
    "Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila",
    "Dietetics Service, San Salvatore Hospital"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 14,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Luca Zagaroli"
    },
    {
      "affs": [
        1
      ],
      "name": "Valentina Cattivera"
    },
    {
      "affs": [
        0
      ],
      "name": "Federica Guerra"
    },
    {
      "affs": [
        2
      ],
      "name": "Sabina Zara"
    },
    {
      "affs": [
        0
      ],
      "name": "Maria Laura Iezzi"
    },
    {
      "affs": [
        0
      ],
      "name": "Gabriella Bottone"
    },
    {
      "affs": [
        0
      ],
      "name": "Claudia Caloisi"
    },
    {
      "affs": [
        0
      ],
      "name": "Cecilia Fabiano"
    },
    {
      "affs": [
        0
      ],
      "name": "Cristina Gentile"
    },
    {
      "affs": [
        0
      ],
      "name": "Giulia Iapadre"
    },
    {
      "affs": [
        0
      ],
      "name": "Giuliana Nanni"
    },
    {
      "affs": [
        0
      ],
      "name": "Laura Palumbo"
    },
    {
      "affs": [
        1
      ],
      "name": "Vincenzo Salpietro"
    },
    {
      "affs": [
        1
      ],
      "name": "Maurizio Delvecchio"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/0wm0pk62jm477.bib",
  "cited_by": 0,
  "doi": "10.3389/fendo.2026.2008253",
  "fulltext_url": null,
  "id": "0wm0pk62jm477",
  "issns": [
    "1664-2392"
  ],
  "landing_url": "https://www.frontiersin.org/articles/10.3389/fendo.2026.2008253/full",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [],
  "openalex": null,
  "pdf_url": null,
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-29",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/0wm0pk62jm477.ris",
  "sources": [
    {
      "first_seen": "2026-10-31T00:21:09Z",
      "native_id": "10.3389/fendo.2026.2008253",
      "source": "crossref",
      "url": "https://www.frontiersin.org/articles/10.3389/fendo.2026.2008253/full"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "issn:1664-2392",
      "subfield": "endocrinology-metabolism"
    }
  ],
  "title": "Case Report: Acute liver injury with Epstein-Barr virus DNAemia following teplizumab: drug-induced liver injury, viral reactivation, or both?",
  "title_text": "Case Report: Acute liver injury with Epstein-Barr virus DNAemia following teplizumab: drug-induced liver injury, viral reactivation, or both?",
  "type": "peer-reviewed",
  "updated_at": "2026-11-01T00:21:06Z",
  "url": "https://research.draconitic.com/paper/0wm0pk62jm477",
  "venue": "Frontiers in Endocrinology",
  "versions": []
}