1/36. sarcoidosis with selective involvement of a second liver allograft: report of a case and review of the literature.A case of sarcoidosis recurrent in a patient's second liver allograft is described. There was no granulomatous disease seen in the patient's first liver allograft. After the second orthotopic liver transplantation (OLT), the patient was successfully treated for acute rejection, aspergillus infection, and cytomegalovirus viremia. Approximately 2 months after the second OLT, the patient was treated with long-term interferon-alpha for recurrent hepatitis c. Five years after the operation, he experienced liver failure secondary to recurrent hepatitis and underwent a third OLT. This is only the second reported case of sarcoidosis recurrent in the liver parenchyma of a transplanted organ and the first in which interferon-alpha might have played a role.- - - - - - - - - - ranking = 1keywords = hepatitis (Clic here for more details about this article) |
2/36. Hepatic sarcoidosis with vanishing bile duct syndrome, cirrhosis, and portal phlebosclerosis. Report of an autopsy case.A few cases of sarcoidosis are associated with progressive liver disease, with a wide variety of clinicopathologic features. Herein, we report an autopsy case (65-year-old man). During an examination for liver dysfunction, cirrhosis with cholestatic dysfunction and splenomegaly were found. Needle liver biopsy revealed cirrhosis with lymphocytic piecemeal necrosis, dense septal fibrosis, and ductopenia. In addition, noncaseating epithelioid granuloma was also seen in the periportal region. Ductal enzymes and immunoglobulin m (IgM) levels were elevated, although antimitochondrial antibodies were negative. Instead, angiotensin-converting enzyme was elevated. He died of pulmonary failure and lung cancer. The autopsy liver (1,220 g) showed multinodular cirrhosis with broad and dense septa that divided the parenchyma. Mild lymphoid cell infiltration was seen in the periportal region. About a half of the interlobular bile ducts were lost, and the remaining bile ducts showed prominent periductal fibrosis, resembling sclerosing cholangitis. Interestingly, a few interlobular bile ducts showed chronic nonsuppurative cholangitis with epithelioid granulomas. Intrahepatic portal veins showed luminal narrowing with prominent phlebosclerosis. Hepatobiliary pathologies that resemble primary biliary cirrhosis and primary sclerosing cholangitis and that are followed by vanishing bile duct syndrome, chronic active hepatitis-related cirrhosis, and intrahepatic portal venous phlebosclerosis occur in a single case of sarcoidosis.- - - - - - - - - - ranking = 0.5keywords = hepatitis (Clic here for more details about this article) |
3/36. Pulmonary sarcoidosis in a patient with essential thrombocythemia treated with interferon alpha: a short case report.A patient with essential thrombocythemia was diagnosed with pulmonary sarcoidosis after interferon alpha therapy. Following interferon treatment the miliary pulmonary dissemination has appeared and after disruption of this therapy it resolved during two months. Few cases of sarcoidosis associated with interferon alpha treatment have been reported. These patients were treated for chronic myelogenous leukemia, chronic hepatitis c, and renal cell carcinoma. We report the first case of interferon-related sarcoidosis in an essential thrombocythemia patient.- - - - - - - - - - ranking = 0.5keywords = hepatitis (Clic here for more details about this article) |
4/36. Granulomatous hepatitis due to sarcoidosis: a case report.A Royal Australian air Force transport pilot is discovered to have abnormal liver function tests during a routine aircrew medical examination. In the preceding 12 mo he had experienced minimal symptoms. Liver biopsy confirmed granulomatous hepatitis, the cause of which was determined to be sarcoidosis. Hilar and paratracheal lymphadenopathy were found on chest radiography. No overt evidence of other pulmonary, cardiac or ocular disease was found. This case illustrates the interesting problem of a clinically well aviator with biochemical abnormalities only, but at risk due to the potential presence of more widely disseminated sarcoidosis.- - - - - - - - - - ranking = 2.5keywords = hepatitis (Clic here for more details about this article) |
5/36. Reactivation of sarcoidosis during interferon therapy.The exacerbation of a co-existing autoimmune disease is often a concern for physicians who use immunomodulating agents for the treatment of a concomitant process. As physicians begin to treat chronic hepatitis c more often and more aggressively, this potential problem with occur more frequently. Herein we reported a case of reactivation of sarcoidosis occurring during the treatment of chronic hepatitis c, and we present a literature review of other centers' experiences with this problem. Depending upon the severity of the exacerbation and the type of organ involvement, reactivation of sarcoidosis may require discontinuation of the interferon therapy, with or without the use of additional steroids. The majority of patients, however, do not require the use of steroids. Interestingly, continuation of the interferon therapy in the presence of a mild-to-moderate exacerbation of sarcoidosis may be safe in a minority of patients with noncritical organ involvement.- - - - - - - - - - ranking = 1keywords = hepatitis (Clic here for more details about this article) |
6/36. sarcoidosis in two patients with chronic hepatitis c treated with interferon, ribavirin and amantadine.We report two patients with chronic hepatitis c, both nonresponders to a previous course of interferon (IFN), who developed or suffered an exacerbation of sarcoidosis while under treatment with IFN-alpha2a, ribavirin and amantadine. Patient 1: symptoms appeared after week 4 and treatment was withdrawn at month 9 due to severe weight loss, marked dyspnea, muscular weakness, dryness of mouth and facial paralysis. Stage III pulmonary sarcoidosis and polyneuropathy were confirmed. The patient had become steroid dependent and nine months after cessation of the treatment dyspnea and muscular weakness still persisted. She achieved a complete sustained response of hepatitis c. Patient 2: presented with a previous diagnosis of granulomatous hepatitis with chronic active hepatitis c and chronic dermatitis. The treatment exacerbated a cutaneous sarcoidosis. Furthermore, hiliar adenopathies consistent with stage I sarcoidosis became evident. sarcoidosis responded to corticosteroids, but elevated transaminases and hepatitis c viraemia resisted. Hence, the combination of amantadine with ribavirin and IFN can develop or exacerbate subclinical sarcoidosis. A synergistic effect of these three drugs is suggested.- - - - - - - - - - ranking = 4.5keywords = hepatitis (Clic here for more details about this article) |
7/36. Cutaneous sarcoidosis during interferon alfa and ribavirin treatment of hepatitis c virus infection: two cases.Interferon-induced sarcoidosis is well documented. We report two new cases of sarcoidosis in two patients with hepatitis c virus infection treated with interferon alfa and ribavirin. These patients developed cutaneous sarcoidosis about 3 months after the beginning of the combination therapy. Spontaneous regression of the lesions was noted after discontinuation of the treatment. There have been more than 20 observations of the appearance or aggravation of this granulomatosis with interferon alfa and more recently with the combination of interferon alfa plus ribavirin. Dermatological signs are found in 50% of cases, and are often diagnostic. Other clinical symptoms of sarcoidosis resemble side-effects of interferon. The evolution is fairly stereotypical and is marked by a regression of the lesions following a dose reduction or curtailment of interferon. Interferon alfa acts by stimulating the T-helper (Th) 1 immune response. In addition to its antiviral action, ribavirin also enhances the Th1 response. Indeed, the superiority of the combination of interferon alfa and ribavirin in terms of antiviral action is corroborated by the enhancement of a Th1-type immune reaction by this combination. At the same time, this immune cell reaction triggers a greater granulomatous reaction.- - - - - - - - - - ranking = 2.5keywords = hepatitis (Clic here for more details about this article) |
8/36. Development of cutaneous sarcoidosis in a patient with chronic hepatitis c treated with interferon alpha 2b.BACKGROUND: sarcoidosis is a multisystemic granulomatous disorder of unknown etiology that most commonly affects young adults. A probable induction of sarcoidosis by interferons (IFN) has been published. To this date, few cases of cutaneous sarcoidosis inpatients with chronic hepatitis c under interferon treatment have been reported. OBJECTIVE: We describe a 50-year-old woman with chronic hepatitis c who developed lesions of cutaneous sarcoidosis three months after IFN treatment. CONCLUSIONS: The possible role of INF therapy in the development of cutaneous sarcoidosis in a patient with chronic hepatitis c should be considered.- - - - - - - - - - ranking = 3.5keywords = hepatitis (Clic here for more details about this article) |
9/36. sarcoidosis-associated hepatitis c virus infection.Although several reports of sarcoidosis have been reported in hepatitis c virus (HCV)-infected patients treated with interferon-alpha, this association has never been described in nontreated HCV patients. We report two cases of sarcoidosis associated with chronic hepatitis c infection. The patients developed multivisceral sarcoidosis (cutaneous, lungs, nodes) at two and at least six years after the presumed date of infection. One patient obtained remission of sarcoidosis with corticosteroid treatment but the other remained corticodependent. The levels of hepatic enzymes were not significantly modified throughout the course of corticosteroid therapy. In conclusion, these case reports suggest that HCV itself could induce a granulomatous reaction in chronic HCV-infected patients through the stimulation of the cellular immune system. It could be of interest to test for HCV infection all patients diagnosed with sarcoidosis and to watch over every treated or nontreated hepatitis c infected patient for the development of granulomatous lesions.- - - - - - - - - - ranking = 3.5keywords = hepatitis (Clic here for more details about this article) |
10/36. Systemic sarcoidosis presenting as a granulomatous tattoo reaction secondary to interferon-alpha treatment for chronic hepatitis c and review of the literature.sarcoidosis is a multisystem granulomatous disease of unknown etiology. Immune alterations involving heightened T-helper-1 responses have been proposed to play a major role in the pathogenesis of sarcoidosis. interferon-alpha therapy and hepatitis c infection have been implicated in the development of a variety of autoimmune diseases. However, despite the wide use of IFN-alpha therapy for hepatitis c, only a few cases of sarcoidosis have been reported in this context. We report the case of a 42-year-old white female with hepatitis c, who developed systemic sarcoidosis shortly after therapy with IFN-alpha2b. The disease was heralded by the appearance of a cutaneous sarcoid/ foreign body granulomatous reaction at the site of an old tattoo. The sarcoidosis responded to a short course of oral prednisone therapy. We also reviewed the other reported cases and discussed the possible immunological mechanisms involved.- - - - - - - - - - ranking = 3.5keywords = hepatitis (Clic here for more details about this article) |
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