{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T05:47:11Z","timestamp":1782539231816,"version":"3.54.5"},"reference-count":25,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T00:00:00Z","timestamp":1782345600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003196","name":"Italian Ministry of Health","doi-asserted-by":"crossref","award":["RC 2026"],"award-info":[{"award-number":["RC 2026"]}],"id":[{"id":"10.13039\/501100003196","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>Pediatric acute liver failure (PALF) is a rare but life-threatening condition characterized by rapid clinical deterioration and high mortality. Viral infections represent a major etiology of PALF, although the causative agent remains unidentified in a substantial proportion of cases. Human Enteroviruses (EVs) are typically associated with self-limiting illnesses; however, they may rarely cause severe systemic disease, including fulminant hepatitis, particularly in neonates and young children. We describe the case of a 4-year-old previously healthy male who presented with acute fulminant hepatitis secondary to systemic Echovirus 25 (E25) infection, with concomitant Epstein\u2013Barr virus (EBV) co-infection of recent onset. The diagnosis was established through multiplex PCR on cerebrospinal fluid, blood, stool, and nasopharyngeal aspirate, with serotype confirmation by the Italian National Institute of Health. The patient required intensive supportive care including therapeutic plasma exchange (TPE), continuous kidney replacement therapy (CKRT), and intravenous immunoglobulins (IGIV). Despite initial clinical deterioration and placement on the liver transplant list, the patient achieved complete hepatic recovery and was discharged after fourteen days of hospitalization without requiring transplantation. This case highlights the importance of prompt virological workup including enterovirus PCR in children presenting with acute liver failure of undetermined etiology and supports the use of extracorporeal therapies as a bridge to recovery.<\/jats:p>","DOI":"10.3390\/pathogens15070666","type":"journal-article","created":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T05:48:16Z","timestamp":1782366496000},"page":"666","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Fulminant Hepatitis Due to Enterovirus E25 Systemic Infection in a Pediatric Patient"],"prefix":"10.3390","volume":"15","author":[{"given":"Silvia","family":"Garattini","sequence":"first","affiliation":[{"name":"Division of Pediatric Infectious Disease, Department for Women\u2019s and Children\u2019s Health, Padua University Hospital, 35128 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4195-6626","authenticated-orcid":false,"given":"Lorenza","family":"Romani","sequence":"additional","affiliation":[{"name":"Infectious Disease Unit, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4933-4242","authenticated-orcid":false,"given":"Luana","family":"Coltella","sequence":"additional","affiliation":[{"name":"Microbiology and Diagnostic Immunology Unit, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3082-855X","authenticated-orcid":false,"given":"Tommaso","family":"Alterio","sequence":"additional","affiliation":[{"name":"Unit of Hepatology and Transplant Clinic, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefania","family":"Mercadante","sequence":"additional","affiliation":[{"name":"Infectious Disease Unit, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6712-2334","authenticated-orcid":false,"given":"Costanza","family":"Tripiciano","sequence":"additional","affiliation":[{"name":"Infectious Disease Unit, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7549-3514","authenticated-orcid":false,"given":"Maia De","family":"Luca","sequence":"additional","affiliation":[{"name":"Infectious Disease Unit, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Chiurchi\u00f9","sequence":"additional","affiliation":[{"name":"Infectious Disease Unit, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Cursi","sequence":"additional","affiliation":[{"name":"Infectious Disease Unit, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6087-8323","authenticated-orcid":false,"given":"Francesca Ippolita Cal\u00f2","family":"Carducci","sequence":"additional","affiliation":[{"name":"Infectious Disease Unit, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6178-5460","authenticated-orcid":false,"given":"Cristina","family":"Russo","sequence":"additional","affiliation":[{"name":"Microbiology and Diagnostic Immunology Unit, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo Federico","family":"Perno","sequence":"additional","affiliation":[{"name":"Microbiology and Diagnostic Immunology Unit, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9120-0424","authenticated-orcid":false,"given":"Alberto","family":"Villani","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS, University of Rome Tor Vergata, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4426-0395","authenticated-orcid":false,"given":"Andrea","family":"Pietrobattista","sequence":"additional","affiliation":[{"name":"Unit of Hepatology and Transplant Clinic, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5672-0881","authenticated-orcid":false,"given":"Stefania","family":"Bernardi","sequence":"additional","affiliation":[{"name":"Infectious Disease Unit, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Lancella","sequence":"additional","affiliation":[{"name":"Infectious Disease Unit, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1026","DOI":"10.1002\/hep.28944","article-title":"Pediatric acute liver failure of undetermined cause: A research workshop","volume":"65","author":"Alonso","year":"2017","journal-title":"Hepatology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"501","DOI":"10.5223\/pghn.2020.23.6.501","article-title":"Differential Diagnosis of Acute Liver Failure in Children: A Systematic Review","volume":"23","author":"Berardi","year":"2020","journal-title":"Pediatr. 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