Fulminant hepatic failure and autoimmune hemolytic anemia associated with Epstein-Barr virus infection.

Acute hepatic failure has been reported in the presence of Epstein-Barr virus (EBV) infection. Autoimmune hemolytic anemia may also occur in the course of this infection. We report a rare case of fulminant hepatic failure and autoimmune hemolytic anemia associated with Epstein-Barr virus. A seven-year-old girl was admitted with the complaints of abdominal pain, vomiting and jaundice. She was irritable, confused and had mild hepatomegaly with marked splenomegaly. Serum aminotransferase levels were moderately elevated, while direct and indirect bilirubin levels were markedly elevated. Prothrombin time was prolonged. Hemoglobin was 3.9 g/dl. Anti-HAV IgM, HbsAg, anti-HBc IgM, anti-HCV and anti-CMV IgM were negative, while IgM VCA EBV, IgG VCA EBV and anti-CMV IgG were positive. Serum copper and ceruloplasmin levels were normal. The patient received supportive therapy for hepatic failure. Meanwhile, the cause of the deep anemia was investigated and autoimmune hemolytic anemia was ascertained by means of increased reticulocyte count and positive Coombs test. Corticosteroid therapy was administered. The prognosis was good. Although not reported before, the combination of acute hepatic failure and autoimmune hemolytic anemia may complicate the course of EBV infection. Physicians need to be aware of this association.

XNEOr: development and evaluation of an expert system to improve the quality and cost of decision-making in neuro-oncology.

The treatment of brain tumors requires a large team of medical experts. However, the process of medical decision-making for these patients is hampered by the frequent inaccessibility of the experts because of conflicting scheduling, inconsistencies in the management of different patients, and the fact that multiple experts often yield multiple opinions. The goals of this work were (1) to develop and validate an expert system to assist the medical team deliver efficient, quality care to children with recurrent medulloblastoma, a common type of pediatric brain tumor, and (2) to determine if the expert system can be used as an educational tool. The results of our study indicate that residents enjoy learning by using XNEOr, the brain tumor expert system. XNEOr enabled residents to order appropriate ancillary tests for patients and to make fewer incorrect treatment decisions. The potential net effect of residents using XNEOr may be increased patient and family satisfaction and decreased probability of medical liability. At a time of important changes in our health care system, novel expert systems hold promise as tools to reduce medical costs, improve the quality of multi-expert medical care, and advance health care education.