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Hepatitis in the oncology patient

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Shared care information

These patients should be discussed, if they are stable, with the paediatric oncologist on call during working hours.


Drugs and infections are the most common causes in oncology patients. Causes include:

  • CMV, Hepatitis viruses (A,B & C), EBV and some respiratory viruses e.g., influenza may be implicated. Adenovirus, particularly if post SCT.
  • Hepatosplenic candidiasis, bacterial or other fungal abcesses are unusual.
  • Sinusoidal Obstructive Syndrome (also known as HVOD) may be confused with viral hepatitis. A consistent feature of SOS is platelet refractoriness related to intravascular consumption of platelets, RUQ pain, weight gain and raised bilirubin.
  • Chemotherapeutic agents and antibiotic-associated hepatitis.


  • Liver ultrasound including Doppler scan if SOS is suspected
  • If infective lesions are identified a biopsy is indicated to investigate for causative agent.


  • Remove any precipitating drugs or other causes where possible
  • Treat identified causes e.g., candida
  • Chemotherapy will usually need to be delayed until resolution of symptoms.

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  • Date last published: 03 March 2014
  • Document type: Clinical Guideline
  • Services responsible: National Child Cancer Network