1/95. Acute fatty liver of pregnancy showing microbial infection in the liver.A 24-year-old, nulliparous woman in her 30th week of pregnancy was admitted due to threatened premature delivery. Ritodrin chloride relieved the premature contraction of the uterus but jaundice and drowsiness appeared 7 weeks later. Laboratory data revealed disseminated intravascular coagulation (DIC) with intrahepatic cholestasis, and ultrasound examination showed fatty liver. The patient was diagnosed with acute fatty liver of pregnancy (AFLP). Emergency delivery by Caesarean section was performed at 37 weeks of pregnancy and the liver function and DIC improved immediately. Liver biopsy 13 days after delivery showed nuclear swelling and cytoplasmic ballooning with mild fatty deposition. These findings were relatively compatible with acute AFLP. Higher magnification and electron microscopy revealed intracytoplasmic bacteria and fungus in the residual stage. The bacterial infection could be considered related to AFLP.- - - - - - - - - - ranking = 1keywords = intrahepatic cholestasis, cholestasis, intrahepatic (Clic here for more details about this article) |
2/95. Chronic graft-versus-host disease after hematopoietic cell transplantation presenting as an acute hepatitis.A variety of illnesses involving the gut and liver follow hematopoietic cell transplantation (HCT). A 20 yr-old white male developed severe acute hepatitis 36 wk (day 252) after matched, unrelated, allogeneic HCT for chronic myelogenous leukemia (CML). Mild skin graft-versus-host disease (GVHD) had occurred at about 20 wk (day 140) after transplant. Liver biopsy showed bile duct injury and a diffuse lobular injury pattern most consistent with a GVHD variant and not reminiscent of drug-induced or viral hepatitis. No findings suggestive of herpesvirus, adenovirus, or varicella-zoster virus were found. High-dose steroids resulted in marked improvement of his liver enzyme levels. We report this patient as representing the acute hepatitic presentation of chronic GVHD of the liver.- - - - - - - - - - ranking = 0.0079785922273273keywords = bile duct, bile, duct (Clic here for more details about this article) |
3/95. Mechanical partial small bowel obstruction in a patient with Fitz-Hugh-Curtis syndrome.Perihepatitis or Fitz-Hugh-Curtis syndrome is a complication of pelvic inflammatory disease that usually leaves characteristic violin string adhesions on the anterior liver surface. These adhesions are common incidental findings on subsequent laparoscopy or laparotomy and are considered benign. We present a case of partial mechanical small bowel obstruction as a sequel of this syndrome that was diagnosed and treated laparoscopically.- - - - - - - - - - ranking = 0.00027613643355641keywords = obstruction (Clic here for more details about this article) |
4/95. Severe cholestatic hepatitis from troglitazone in a patient with nonalcoholic steatohepatitis and diabetes mellitus.Troglitazone is currently approved for the treatment of diabetes mellitus. Hepatic abnormalities have been reported in up to 1.9% of patients receiving the drug. Severe hepatotoxicity, including the need for liver transplantation, has also been reported in patients treated with troglitazone. Troglitazone has been reported to be beneficial in a small group of patients with nonalcoholic steatohepatitis (NASH). We present a patient with nonalcoholic steatohepatitis and diabetes mellitus who developed severe cholestasis after treatment with troglitazone. The exact mechanism of troglitazone toxicity is unknown, and whether preexisting liver abnormalities increase the incidence of toxicity is speculative. Further data are needed before more widespread use of troglitazone can be recommended for patients with nonalcoholic steatohepatitis.- - - - - - - - - - ranking = 0.34410522444718keywords = cholestasis (Clic here for more details about this article) |
5/95. Hepatic graft-versus-host disease presenting as an acute hepatitis after allogeneic peripheral blood stem cell transplantation.Hepatic graft-versus-host disease (GVHD) generally presents as cholestatic jaundice, and increased serum alkaline phosphatase (ALP) is followed by hyperbilirubinemia and clinical jaundice. Currently accepted standards for evaluating the clinical severity of GVHD are based not on serum aminotransferase levels but on the serum bilirubin level. We describe a 17-year-old Japanese female who had increased aminotransferases without cholestasis on day 23 after allogeneic peripheral blood stem cell transplantation (allo-PBSCT). Liver biopsy revealed lymphocytic infiltration of the portal tracts and pericentral necrosis of the lobuli. The limiting plates were not clearly defined due to cellular infiltrates. There was periductal lymphocytic infiltration and vacuolization of the biliary epithelial cells with exocytosis, compatible with GVHD of cholangiohepatitic type. These findings indicate that acute hepatic GVHD may present as acute hepatitis and this should be included in the differential diagnosis for patients with increased aminotransferases after allogeneic stem cell transplantation.- - - - - - - - - - ranking = 0.34431197545276keywords = cholestasis, duct (Clic here for more details about this article) |
6/95. Fibrosing cholestatic hepatitis-like syndrome in hepatitis b virus-negative and hepatitis c virus-negative renal transplant recipients.Cholestatic hepatitis and diffuse liver fibrosis have been described in immunosuppressed patients with hepatitis b virus or hepatitis c virus infection as fibrosing cholestatic hepatitis (FCH). FCH is characterized by cholestasis, with only a modest increase in aminotransferase levels. The pathologic picture typically shows periportal and perisinusoidal fibrosis, scarce mixed infiltrates, hepatocellular ballooning, and histologic cholestasis. We report two patients with diffuse fibrosis and cholestasis quite similar to the histologic picture of FCH, but in whom neither hepatitis b virus nor hepatitis c virus infection could be shown, highlighting the potential contribution of cytomegalovirus infection and azathioprine toxicity in the development of this severe complication of solid-organ transplantation.- - - - - - - - - - ranking = 1.0323156733415keywords = cholestasis (Clic here for more details about this article) |
7/95. Depletion of mitochondrial dna in the liver of an infant with neonatal giant cell hepatitis.A boy presented with lactic acidosis, hepatomegaly, hypoglycemia, generalised icterus, and muscle hypotonia in the first weeks of life. At the age of 2 months, neonatal giant cell hepatitis was diagnosed by light microscopy. Electron microscopy of the liver revealed an accumulation of abnormal mitochondria and steatosis. Skeletal muscle was normal on both light and electron microscopy. At the age of 5 months, the patient died of liver failure. Biochemical studies of the respiratory chain enzymes in muscle showed that cytochrome-c oxidase (complex IV) and succinate-cytochrome-c oxidoreductase (complex II III) activities were (just) below the control range. When related to citrate synthase activity, however, complex IV and complex II III activities were normal. Complex I activity was within the control range. The content of mitochondrial dna (mtDNA) was severely reduced in the liver (17% to 18% of control values). Ultracytochemistry and immunocytochemistry of cytochrome-c oxidase demonstrated a mosaic pattern of normal and defective liver cells. In defective cells, a reduced amount of the mtDNA-encoded subunits II-III and the nuclear dna-encoded subunits Vab was found. Cells of the biliary system were spared. immunohistochemistry of mtDNA replication factors revealed normal expression of dna polymerase gamma. The mitochondrial single-stranded binding protein (mtSSB) was absent in some abnormal hepatocytes, whereas the mitochondrial transcription factor A (mtTFA) was deficient in all abnormal hepatocytes. In conclusion, depletion of mtDNA may present as giant cell hepatitis. mtTFA and to a lesser degree mtSSB are reduced in mtDNA depletion of the liver and may, therefore, be of pathogenetic importance. The primary defect, however, is still unknown.- - - - - - - - - - ranking = 0.00020675100558173keywords = duct (Clic here for more details about this article) |
8/95. Sickle cell erythrostasis and non-specific hepatitis and peritonium tubercle hyperplasia. Case report.Hepatic and bile duct involvement are common in sickle cell disease. This is a histopathological case report of a 40 year old female with sickle cell non-specific hepatitis and peritoneum tubercle hyperplasia. The histopathology diagnosis of liver biopsy was erythrostasis and non-specific hepatitis and for peritoneal tubercle was non-specific chronic inflammation with mesothelial hyperplasia. Involvement in a subgroup of patients with SCD. Hepatic and bile duct involvement are common in sickle cell disease. It is recommended that for dyspeptic SCD patients diagnostic labroscopy could be helpful in the diagnosis of peritoneal tubercle, therefore for performing the histopathology of peritoneal tubercle biopsy sections.- - - - - - - - - - ranking = 0.015957184454655keywords = bile duct, bile, duct (Clic here for more details about this article) |
9/95. OKT3 (muromonab-cd3) associated hepatitis in a kidney transplant recipient.The introduction of OKT3 (muromonab-cd3) revolutionized the management of steroid-resistant rejection in transplant patients. Indeed, after the success of OKT3 for treatment of rejection, some centers used OKT3 for perioperative prophylaxis against rejection after transplantation. Despite the success of this agent for prevention and treatment of rejection, its use is associated with side effects. These side effects, including the cytokine release syndrome and flash pulmonary edema, are well recognized in the transplant community. However, there have been no published reports of acute severe hepatitis associated with the use of OKT3 in non-liver transplant patients. We describe here a case of acute severe hepatitis encountered during treatment of acute renal allograft rejection with OKT3 in a 31-year-old black man.- - - - - - - - - - ranking = 0.00020675100558173keywords = duct (Clic here for more details about this article) |
10/95. Hepatic graft-versus-host disease resembling acute hepatitis: additional treatment with ursodeoxycholic acid.Hepatic graft-versus-host disease (GVHD) is a frequent complication after bone-marrow transplantation (BMT). The disease is often refractory to immunosuppressive therapy. We present a 30-year-old Japanese male, who developed an abrupt elevation of aminotransferases, on day 135 after allogeneic BMT. A liver biopsy specimen revealed degeneration of the small bile ducts and portal fibrosis, and the diagnosis of chronic hepatic GVHD was confirmed. No manifestation of chronic GVHD was observed except liver dysfunction. The administration of prednisolone (PSL) and cyclosporin (CsA) ameliorated laboratory data to a degree, but they did not return to normal. Treatment with ursodeoxycholic acid (UDCA), subsequently added to the immunosuppressive therapy, apparently normalized the levels of biliary tract enzyme and total bilirubin. His liver function test completely returned to normal on day 260. We believe that it is worthwhile to administer UDCA as an additional treatment for not only common hepatic GVHD but also atypical cases presenting as acute hepatitis.- - - - - - - - - - ranking = 0.0079785922273273keywords = bile duct, bile, duct (Clic here for more details about this article) |
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