{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T11:18:38Z","timestamp":1763032718235,"version":"3.45.0"},"reference-count":34,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T00:00:00Z","timestamp":1761177600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Viral Hepatitis"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>In recent years, an increasing number of acute liver failure (ALF) cases have been attributed to HHV\u20106, although its pathogenic role remains debated. In the absence of standardised diagnostic criteria, HHV\u20106 is likely underrecognized as a potential etiologic agent. We report three cases of liver injury with confirmed HHV\u20106 replication; each showing a markedly different degree of viral involvement. A narrative review of all previously reported cases of HHV\u20106\u2010induced hepatitis in immunocompetent adults was conducted. Based on the available evidence, an algorithm was designed for the management of HHV\u20106\u2010associated liver injury. Twenty cases were included, showing a predominance of young women (80%), fever as the most consistent symptom (75%), and a notable association (30%) with Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome. Overall, 65% of patients met ALF criteria, and mortality reached 30%. Blood RT\u2010PCR was the most frequently used diagnostic tool (70%), while liver biopsy was performed in 35% of cases. Antiviral therapy was administered in 45% of patients and corticosteroids in 40%, mainly due to coexisting DRESS syndrome or initial suspicion of autoimmune hepatitis. Notably, 25% of patients underwent liver transplantation. The proposed algorithm offers a structured approach to managing HHV\u20106 in patients with ALF and emphasises the importance of considering it in the differential diagnosis. HHV\u20106 should be considered in cases of ALF, particularly in young febrile women without an identified aetiology and in patients with concomitant DRESS syndrome. Further studies are needed to validate diagnostic criteria and guide treatment strategies.<\/jats:p>","DOI":"10.1111\/jvh.70100","type":"journal-article","created":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T11:32:37Z","timestamp":1761219157000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Human Herpesvirus 6 in Acute Liver Failure: Leading Role, Supporting Actor or Innocent Bystander? A Case Series, Narrative Review and Management Algorithm Proposal"],"prefix":"10.1111","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9537-6032","authenticated-orcid":false,"given":"Andr\u00e9s","family":"Conthe","sequence":"first","affiliation":[{"name":"Department of Gastroenterology &amp; Hepatology Hospital General Universitario Gregorio Mara\u00f1\u00f3n  Madrid Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red Enfermedades Hep\u00e1ticas y Digestivas (CIBERehd)  Madrid Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pablo Ram\u00f3n","family":"Fueyo","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology &amp; Hepatology Hospital General Universitario Gregorio Mara\u00f1\u00f3n  Madrid Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fernando","family":"Aguilera","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology &amp; Hepatology Hospital General Universitario Gregorio Mara\u00f1\u00f3n  Madrid Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlos","family":"Iniesta","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology &amp; Hepatology Hospital General Universitario Gregorio Mara\u00f1\u00f3n  Madrid Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-3314-4786","authenticated-orcid":false,"given":"Yolanda","family":"Rubio","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology &amp; Hepatology Hospital General Universitario Gregorio Mara\u00f1\u00f3n  Madrid Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4700-0281","authenticated-orcid":false,"given":"Fernando","family":"D\u00edaz Fontenla","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology &amp; Hepatology Hospital General Universitario Gregorio Mara\u00f1\u00f3n  Madrid Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red Enfermedades Hep\u00e1ticas y Digestivas (CIBERehd)  Madrid Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0309-2727","authenticated-orcid":false,"given":"Luis","family":"Ib\u00e1\u00f1ez Samaniego","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology &amp; Hepatology Hospital General Universitario Gregorio Mara\u00f1\u00f3n  Madrid Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red Enfermedades Hep\u00e1ticas y Digestivas (CIBERehd)  Madrid Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Vega","family":"Catalina","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology &amp; Hepatology Hospital General Universitario Gregorio Mara\u00f1\u00f3n  Madrid Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red Enfermedades Hep\u00e1ticas y Digestivas (CIBERehd)  Madrid Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rafael","family":"Ba\u00f1ares","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology &amp; Hepatology Hospital General Universitario Gregorio Mara\u00f1\u00f3n  Madrid Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red Enfermedades Hep\u00e1ticas y Digestivas (CIBERehd)  Madrid Spain"},{"name":"Facultad de Medicina Universidad Complutense de Madrid  Madrid Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,10,23]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.00122-14"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(24)00693-7"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(89)92077-1"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199105023241818"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199307153290304"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejim.2003.09.004"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2796.2005.01567.x"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/1757-1626-1-110"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.humpath.2008.08.017"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2334-10-49"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.transproceed.2011.01.142"},{"issue":"12","key":"e_1_2_7_13_1","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1016\/j.annfar.2014.10.003","article-title":"H\u00e9patite Fulminante et D\u00e9faillance Multivisc\u00e9rale Imput\u00e9es au HHV\u20106 Chez Une Patiente de 24Ans","volume":"33","author":"Cl\u00e9ron B.","year":"2014","journal-title":"Annales Fran\u00e7aises D'anesth\u00e9sie et de R\u00e9animation"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gastrohep.2015.09.003"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcv.2015.12.002"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.12659\/AJCR.928587"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccr3.3218"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.2169\/internalmedicine.8985-21"},{"issue":"9","key":"e_1_2_7_19_1","article-title":"Reactivation of Human Herpesvirus (HHV) 6 as Etiology of Acute Liver Injury in Drug Reaction With Eosinophilia and Systemic Symptoms (DRESS) Syndrome: A Case Report","volume":"14","author":"Li J. 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