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Nardelli MJ, Cançado GGL, Naves GNT, Vidigal PVT, Couto CA. Autoimmune hepatitis presenting with peripheral eosinophilia: Case report and literature review. Transpl Immunol 2022; 74:101671. [PMID: 35842079 DOI: 10.1016/j.trim.2022.101671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 07/10/2022] [Accepted: 07/10/2022] [Indexed: 11/29/2022]
Abstract
Acute hepatitis presenting with blood eosinophilia are scarcely reported. Different clinical courses of autoimmune hepatitis (AIH) have been associated with acute hepatitis with eosinophilia, however it is still unclear if the latter is a common manifestation of different autoimmune diseases, part of a similar spectrum of eosinophil-associated liver injury or even a trigger to AIH. We report a case of a 32 years old woman who presented with subacute hepatitis, peripheral eosinophilia, hypergammaglobulinemia and liver biopsy suggestive of AIH. The role of eosinophils in autoimmune liver diseases deserves further studies in order to clarify its physiopathology aspects.
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Affiliation(s)
| | - Guilherme Grossi Lopes Cançado
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Instituto Alfa de Gastroenterologia, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Gabriel Nino Taroni Naves
- Instituto Alfa de Gastroenterologia, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Paula Vieira Teixeira Vidigal
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Instituto Alfa de Gastroenterologia, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Claudia Alves Couto
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Instituto Alfa de Gastroenterologia, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
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2
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Tange S, Uchino K, Kakiwaki H, Suzuki H, Yamamoto S, Ito Y, Taniguchi H, Shirai H, Suzuki T, Onoyama H, Nagaoka S, Kumasaka T, Yoshida H. Acute Liver Failure Due to Hypereosinophilic Syndrome Accompanied by Duodenal Perforation. Intern Med 2022; 61:1525-1529. [PMID: 34670898 PMCID: PMC9177379 DOI: 10.2169/internalmedicine.8283-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 78-year-old woman presenting with severe acute liver failure was admitted to our hospital. On screening for the etiology of acute liver failure, it was diagnosed as being due to idiopathic hypereosinophilic syndrome (eosinophil count reported as 4766/μL; 33.8% of the white blood cells). Her medical history included marked eosinophilia, as observed six months prior to this admission. Corticosteroid therapy was initiated. During the clinical course, duodenal perforation occurred but was managed promptly by appropriate surgery. A liver biopsy, following the initiation of corticosteroid therapy, revealed degenerating hepatic cells with mild eosinophilic infiltration. With corticosteroid therapy, the liver function improved.
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Affiliation(s)
- Shuichi Tange
- Department of Gastroenterology, Japanese Red Cross Medical Center, Japan
| | - Koji Uchino
- Department of Gastroenterology, Japanese Red Cross Medical Center, Japan
| | - Hirotoshi Kakiwaki
- Department of Gastroenterology, Japanese Red Cross Medical Center, Japan
| | - Hirobumi Suzuki
- Department of Gastroenterology, Japanese Red Cross Medical Center, Japan
| | - Shinzo Yamamoto
- Department of Gastroenterology, Japanese Red Cross Medical Center, Japan
| | - Yukiko Ito
- Department of Gastroenterology, Japanese Red Cross Medical Center, Japan
| | | | - Harumi Shirai
- Department of Allergy and Rheumatology, Japanese Red Cross Medical Center, Japan
| | - Takeshi Suzuki
- Department of Allergy and Rheumatology, Japanese Red Cross Medical Center, Japan
| | - Haruna Onoyama
- Department of Gastroesophageal Surgery, Japanese Red Cross Medical Center, Japan
| | - Sakae Nagaoka
- Department of Gastroesophageal Surgery, Japanese Red Cross Medical Center, Japan
| | - Toshio Kumasaka
- Department of Pathology, Japanese Red Cross Medical Center, Japan
| | - Hideo Yoshida
- Department of Gastroenterology, Japanese Red Cross Medical Center, Japan
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3
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Matsumoto Y, Ogawa K, Shimizu A, Nakamura M, Hoki S, Kuroki S, Yano Y, Ikuta K, Senda E, Shio S. Inflammatory Pseudo-tumor of the Liver Accompanied by Eosinophilia. Intern Med 2021; 60:2075-2079. [PMID: 33551405 PMCID: PMC8313915 DOI: 10.2169/internalmedicine.6303-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
A 28-year-old woman was referred to our hospital for liver dysfunction and neck pain. Blood tests revealed elevated liver enzymes and eosinophilia. Ultrasonography, computed tomography, and magnetic resonance imaging showed a mass lesion near the hepatic hilus. The tumor was considered to be an inflammatory pseudo-tumor or malignancy. A liver-mass biopsy was performed and led to a diagnosis of inflammatory pseudo-tumor. In the present case, a markedly elevated eosinophil count was a characteristic clinical feature, and the patient underwent steroid therapy. Treatment resulted in a reduced eosinophil count, improved neck symptoms, and disappearance of the inflammatory pseudo-tumor.
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Affiliation(s)
| | - Kento Ogawa
- Division of Gastroenterology, Shinko Hospital, Japan
| | - Akiko Shimizu
- Division of Gastroenterology, Shinko Hospital, Japan
| | | | - Shinya Hoki
- Division of Gastroenterology, Shinko Hospital, Japan
| | | | | | - Kozo Ikuta
- Division of Gastroenterology, Shinko Hospital, Japan
| | - Eri Senda
- Division of Gastroenterology, Shinko Hospital, Japan
| | - Seiji Shio
- Division of Gastroenterology, Shinko Hospital, Japan
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Abstract
The objective of this investigation was to study the gastrointestinal and hepatic
involvement in hypereosinophilic syndrome (HES). Gastrointestinal or hepatic involvement
is estimated to affect up to one-third of patients with HES, although most of the clinical
evidence has been derived from case reports. In literature, HES presenting with hepatitis
and jaundice with subsequent development of colitis is a rare clinicopathologic entity.
Given the clinical implications, physicians should include HES among differentials in
these types of presentations.
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Affiliation(s)
- Faisal Inayat
- Department of Medicine, New York-Presbyterian Hospital, Weill Cornell Medical College, New York City, NY, USA
| | - Abu Hurairah
- Division of Gastroenterology, Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
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5
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Shen T, Gu D, Zhu Y, Shi J, Xu D, Cao X. The value of eosinophil VCS parameters in predicting hepatotoxicity of antituberculosis drugs. Int J Lab Hematol 2016; 38:514-9. [PMID: 27319362 DOI: 10.1111/ijlh.12532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 02/22/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Drug-induced liver injury (DILI) is the most frequent cause of discontinuation of antituberculosis medication and difficult to predict. In recent years, liver eosinophilia has been associated with incidence of DILI. We hypothesize that morphologic changes in reactive eosinophils associated with DILI may be determined by LH750 (Beckman Coulter, Fullerton, CA) with VCS technology. METHODS The absolute eosinophil (AEC), percentage of eosinophil (EOSI%), VCS parameters, and standard deviation (SD) of 500 health controls, 376 patients without DILI, and 50 DILI patients were compared in terms of diagnostic sensitivity and specificity for DILI. RESULTS In DILI patients, the increased mean eosinophil volume (MEV) and size variability (MEV-SD) were observed prior to alanine aminotransferase (ALT) elevations. The MEV was correlated well with ALT after therapy. The ROC curve analyses revealed that the MEV and MEV-SD had larger areas under curves (0.894, 0.815, in the week prior to DILI) compared to other parameters. Using a cutoff of 163.15 fL for the MEV and a cutoff of 17.11 for MEV-SD, the sensitivities of 81% and 72% and specificities of 82% and 80% were achieved, respectively, which are higher than other parameters prior to DILI occurred. CONCLUSIONS The MEV with size variability (MEV-SD) is a quantitative, objective, and more sensitive parameter and has a potential to be an additional indicator for DILI.
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Affiliation(s)
- T Shen
- Department of Laboratory, The Sixth People's Hospital of Nantong, Nantong Jiangsu, China
| | - D Gu
- Department of Laboratory, The Sixth People's Hospital of Nantong, Nantong Jiangsu, China
| | - Y Zhu
- Department of Laboratory, The Second Affiliated Hospital of Nantong University, Nantong Jiangsu, China
| | - J Shi
- Department of Tuberculosis, The Sixth People's Hospital of Nantong, Nantong Jiangsu, China
| | - D Xu
- CBLPath Inc., Rye Brook, NY, USA
| | - X Cao
- Department of Laboratory, The Second Affiliated Hospital of Nantong University, Nantong Jiangsu, China.
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Cheung AC, Hachem CY, Lai J. Idiopathic hypereosinophilic syndrome presenting with hepatitis and achalasia. Clin J Gastroenterol 2016; 9:238-42. [PMID: 27294613 DOI: 10.1007/s12328-016-0661-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 05/31/2016] [Indexed: 02/05/2023]
Abstract
Idiopathic hypereosinophilic syndrome (HES) is a rare diagnosis defined by the World Health Organization as a persistent eosinophilia for 6 months and resulting in end-organ dysfunction. While many patients present with nonspecific symptoms, others will present with symptoms of the affected organs, most commonly those involving the heart, skin, or nervous system. Gastrointestinal or liver involvement is estimated to affect up to one-third of patients with HES, although patients with clinically significant disease are limited to case reports. This is the first report of a patient presenting with hepatitis and achalasia related to idiopathic HES.
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Affiliation(s)
- Amanda C Cheung
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, SSM Health Saint Louis University Hospital, 3635 Vista Avenue, Saint Louis, MO, 63110, USA.
| | - Christine Y Hachem
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, SSM Health Saint Louis University Hospital, 3635 Vista Avenue, Saint Louis, MO, 63110, USA
| | - Jinping Lai
- Division of Anatomic Pathology, Department of Pathology, SSM Health Saint Louis University Hospital, Saint Louis, MO, USA
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Kawamura T, Hiraoka A, Toshimori A, Ueki H, Kaneto M, Aibiki T, Okudaira T, Yamago H, Nakahara H, Tomida H, Suga Y, Azemoto N, Mori K, Miyata H, Ninomiya T, Hirooka M, Abe M, Matsuura B, Hiasa Y, Kito K, Michitaka K. A Possible Case of Hepatitis due to Hypereosinophilic Syndrome. Intern Med 2016; 55:1453-8. [PMID: 27250051 DOI: 10.2169/internalmedicine.55.5982] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 63-year-old Japanese man whose white blood cell count and total-bilirubin and aminotransferase levels were elevated was referred to our hospital. Computed tomography did not reveal any abnormalities, and there was no evidence of gastritis or colitis on esophagogastroduodenoscopy. Although the patient had no history of drug use or allergies, a high concentration of eosinophils (80%) was noted. A liver biopsy revealed hepatitis with eosinophilic infiltration. The patient's alanine aminotransferase and eosinophil levels improved with the administration of steroids. A second biopsy, performed 6 months later, showed the improvement of the eosinophilic infiltration. The patient was diagnosed with eosinophilic hepatitis due to the presence of hypereosinophilic syndrome without the dysfunction of other organs.
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Affiliation(s)
- Tomoe Kawamura
- Gastroenterology Center, Ehime Prefectural Central Hospital, Japan
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van der Eb AJ, van Kesteren LW, van Bruggen EF. Structural properties of adenovirus DNA's. Exp Ther Med 1969; 15:2739-2748. [PMID: 29456677 PMCID: PMC5795490 DOI: 10.3892/etm.2018.5743] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 11/16/2017] [Indexed: 12/21/2022] Open
Abstract
The current study presents the case of a 9-year-old Chinese boy who presented with eosinophilia and elevated serum levels of immunoglobulin G4 (IgG4). A bone marrow puncture identified an elevated eosinophil rate of 23% (normal range, <5%), which indicated eosinophilia. However, gene analysis, fluorescent in situ hybridization and other examinations, including bone marrow aspiration, blood routine, auto-antibody tests and parasitic and allergens screening, contradicted a diagnosis of secondary or clonal eosinophilia. Furthermore, the patient exhibited multiple lymph node swelling and a lymph biopsy strongly indicted a pathological diagnosis of IgG4-related disease (IgG4-RD). His peripheral blood flow cytometry confirmed an elevated count of plasmablasts, which is specific to IgG4-RD. The patient responded well to therapy with prednisone and remained healthy in all follow-ups. By taking all these factors into consideration, the boy was diagnosed with IgG4-RD. It is difficult to distinguish IgG4-RD from hypereosinophilic syndrome and the potential association between the two remains unclear. However, the present case study serves as a reminder that IgG4-RD may occur in children and medical professionals should not neglect this possibility.
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