Cases reported "Hepatitis A"

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1/13. Allogenic bone marrow transplantation with a donor presenting with an acute hepatitis A.

    We report the unique occurrence of an allogenic bone marrow transplantation performed as the donor was suffering from an acute hepatitis A. The bone marrow was contaminated at the time of collection, as demonstrated by hepatitis a virus (HAV) rna detected by RT-PCR. hepatitis a virus infection in such a situation could have resulted in a severe liver disease in the recipient. However, although we could demonstrate that the recipient had been infected, he did not develop a symptomatic hepatitis A but only minor disturbances of liver function tests between days 35 and 55. Both the postponement of the transplantation and the use of intravenous polyvalent immunoglobulins have probably played a key role in decreasing the viral load and allowing a rapid clearance of the virus. A possible role of the grafted immune system might also be envisaged, as suggested by the de novo synthesis of IgM in the recipient.
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2/13. thrombocytopenia and emperipolesis in a patient with hepatitis a infection.

    lmmune thrombocytopenia is a benign, self-limiting disease in children, responding well to treatment and generally associated with viral infections. A 13-year-old girl was admitted to a hospital with the epistaxis and purpura after an attack of jaundice 6 weeks before. The diagnosis of hepatitis a virus (HAV)-induced thrombocytopenia was made. Furthermore, erythrophagocytosis by megakaryocytes was demonstrated in the bone marrow of the patient. Although hematologic complications following hepatitis b and C viruses are commonly reported, the association of hepatitis a virus and thrombocytopenia has rarely been described.
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3/13. hepatitis a virus infection associated with hemophagocytic syndrome: report of two cases.

    Virus-associated hemophagocytic syndrome (VAHS) is reported to be a rare complication in hepatitis a virus infections. We encountered two patients with hepatitis a virus-associated hemophagocytic syndrome (HAV-AHS). Although hemophagocytosis associated with other types of virus infections is fatal, the present patients with HAV-AHS recovered well without any treatment. thrombocytopenia is an initial important finding of VAHS which is not rare in patients with acute hepatitis A. If bone marrow aspiration is performed more frequently, more HAV-AHS will be diagnosed. Further investigations are necessary to clarify the clinical features of HAV-AHS in more patients.
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4/13. Hemophagocytic syndrome associated with fulminant hepatitis A: a case report.

    A 37-year-old man had a sore throat and pyrexia since January 1999. He was treated at a nearby hospital, but not improved. jaundice was indicated there, and the patient was referred transferred to our hospital, where he was admitted for treatment with a diagnosis of severe acute hepatitis with acute renal failure. Thereafter the patient was revealed to have had a past history of heavy drinking, and he underwent the treatment with a diagnosis of acute fulminant hepatitis due to hepatitis a virus (HAV). He showed a tendency toward improvement. During the course, however, viral associated hemophagocytic syndrome (VAHS) developed. Various treatments were conducted, but it was not improved, and the patient died on Hospital Day 66. On pathologic autopsy, remarkable hepatosplenomegaly associated with marked bone marrow abnormalities compatible with VAHS was observed. aspergillus abscesses were also observed in many organs, and they were considered as an adverse reaction to potent immunosuppressive therapy. Since there have been only a few reports on HAV-related VAHS, discussing VAHS related to HAV, the present case was considered valuable.
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5/13. fibrin ring granulomas in hepatitis A.

    fibrin ring granuloma is characterized by a fibrinous ring surrounding a central fat vacuole. It has been found in the liver and bone marrow of patients with q fever, and occasionally with visceral leishmaniasis, cytomegalovirus, Epstein-Barr virus, staphylococcus epidermidis infections, Hodgkin's lymphoma, and hypersensitivity to allopurinol. We describe a case of serologically confirmed viral hepatitis A with this lesion in the liver biopsy. A false positive anti-hepatitis a virus IgM result has been excluded. This is, to our knowledge, the second reported case of type A hepatitis with hepatic fibrin ring granulomas. It confirms that hepatitis A should be included in the differential diagnosis of this lesion.
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6/13. pancytopenia in a child associated with hepatitis A infection.

    pancytopenia is a very rare condition associated with hepatitis A infection. We managed a 12 year old boy who had hepatitis A infection with anemia. His hemogram and bone marrow examination were suggestive of pancytopenia. pancytopenia recovered without any specific therapy. There are case reports of severe aplastic anemia with hepatitis A infection that required immunosuppressive therapy. The present case did not require any aggressive therapy and recovered. In a young child with hepatitis A infection and anemia, bone marrow depression should be suspected. The pancytopenia may be transient as exemplified by the present case.
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7/13. Aplastic anemia associated with type A viral hepatitis--possible role of t-lymphocytes.

    Posthepatitic aplastic anemia (PHAA) is rather uncommon. Most reported cases have developed after non-A, non-B or B type hepatitis. The only case of PHAA occurring after hepatitis A reported so far, was described by Smith et al., who diagnosed it by the long-term elevation of IgG-class antibody in response to hepatitis a virus. Recently, the detection of IgM-class antibody specific against hepatitis a virus (IgM anti-HAV) has been commonly employed for precise diagnosis of hepatitis A. The case reported here is the first case of PHAA occurring after hepatitis A to be diagnosed by radioimmunoassay of IgM anti-HAV. Furthermore, evidence is presented suggesting that the PHAA may have been an immune-related response. Addition of the patient's peripheral t-lymphocytes to cultures of her own bone marrow cells resulted in a reduction in the number of colony-forming units in culture (CFU-C).
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8/13. Immune thrombocytopenic purpura associated with hepatitis A.

    A 23-year-old man developed thrombocytopenic purpura at the end of the second week of the clinical evolution of hepatitis A confirmed by viral markers. The bone marrow of this patient showed megakaryocytic hyperplasia. Circulating in his serum immune complexes were demonstrated by solid phase conglutinin enzymo-immunoassay. Platelet-reactive serum factors were also detected by an indirect immunofluorescence test using fresh donor platelets as targets. The evolution of both the hepatitis and the purpura were benign with no therapy other than bedrest. platelet count normalized within five weeks of the onset of purpura, and IgM antibodies against hepatitis a virus as well as circulating immune complexes dropped to normal levels. It is postulated that the thrombocytopenia of this case was caused by nonspecific deposition of immune complexes at the platelet surface.
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9/13. Suppression of mixed lymphocyte reactivity by cellular and humoral factors in aplastic anemia--both before and after bone marrow transplantation.

    A patient with infectious hepatitis who developed severe aplastic anemia received a bone marrow transplant from her HLA-identical, mixed lymphocyte culture (MLC)-negative sister. It was found that pretreatment of normal lymphocytes with the immunoglobulin fraction of the patient's serum resulted in marked inhibition of their proliferative response to mitogens, as well as their ability to serve as stimulators and responders in MLC. The patient's lymphocytes, unlike those of her HLA-identical sister were unable to stimulate and respond in MLC and markedly suppressed mixed lymphocyte reactivity between two unrelated healthy individuals. Donor-type lymphocytes obtained from the patient after engraftment were also unable to respond or stimulate in MLC. It is suggested that the suppression of lymphocyte responses was mediated by an immunoglobulin present in the patient's serum.
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10/13. in situ hybridization studies of hepatitis A viral rna in patients with acute hepatitis A.

    in situ hybridization with oligonucleotide probes has been used to localise hepatitis a virus rna genomic sequences in formalin-fixed and routinely processed human liver biopsies from three patients. Using radiolabelled Sulphur-35 antisense probes, viral genomic sequences were found in all three cases, but signal intensity was greatest in cases 1 and 2 with fulminant hepatitis, and was minimal in the third case of resolving hepatitis biopsied 2 months after acute illness. Localisation showed the viral rna to be present in hepatocytes, sinusoidal cells and inflammatory cells in and around the portal tracts. Both cases showed signal in similar cell types, but the distribution of staining was predominantly periportal in case 1, whereas lobular staining was more apparent in case 2. Hybridization with sense polarity probes failed to detect any evidence of replicative intermediates of antigenomic viral rna. The presence of hepatitis A rna in phagocytic cells was confirmed using immunohistochemistry for a macrophage marker, CD68, combined with in situ hybridization. In all cases the signal was predominantly cytoplasmic, and this was confirmed with the use of tritiated probes.
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