1
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Ali AF, Haffar L. Turner syndrome with isochromosome Xq as a cause of granulomatous hepatitis: a case report. Ann Med Surg (Lond) 2024; 86:4152-4155. [PMID: 38989171 PMCID: PMC11230761 DOI: 10.1097/ms9.0000000000002042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 03/30/2024] [Indexed: 07/12/2024] Open
Abstract
Introduction Turner syndrome (TS) is the most common sex chromosome abnormality in women, caused by a complete or partial absence of the second sex chromosome. The karyotype 46, X,i(Xq) is the underlying cause in about 10% of the cases of TS. Hepatic abnormalities are frequent in TS. Granulomas are relatively common in liver samples but are very rarely reported in TS. Case presentation A 15-year-old female with TS attended a consultation for evaluation of elevated liver enzymes. Her chromosomal analysis showed mosaicism 46, X (iso xq)100%. There were no stigmata of chronic liver disease. A liver biopsy showed granulomatous hepatitis. Other causes of hepatic granulomas have been excluded. Ursodeoxycholic acid (UDCA) therapy leads to the normalization of transaminases. Clinical discussion Although Hepatic involvement is common and mostly asymptomatic in TS, the mechanism of liver injury is not well understood. The hepatic histological changes in these cases are variable and range from minimal abnormalities to nonalcoholic steatohepatitis (NASH), liver architectural changes, and biliary lesions. Hepatic granulomas are associated with a wide range of systemic disorders but are very rarely reported in tuner syndrome. Normalization of liver enzymes after treatment with UDCA was previously reported, but the importance of this approach is to be determined. Conclusion Granulomatous hepatitis may be associated with TS and may be added to the histological patterns encountered in this disorder.
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Affiliation(s)
- Ayman F. Ali
- Faculty of Medicine, Damascus University, Damascus, Syria
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2
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Hepatobiliary Impairments in Patients with Inflammatory Bowel Diseases: The Current Approach. GASTROENTEROLOGY INSIGHTS 2022. [DOI: 10.3390/gastroent14010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Inflammatory bowel disease (IBD) refers to chronic conditions with a low mortality but high disability. The multisystemic nature of these diseases can explain the appearance of some extraintestinal manifestations, including liver damage. Abnormal liver biochemical tests can be identified in approximately one third of patients with IBD and chronic liver disease in 5% of them. Among the liver diseases associated with IBD are primary sclerosing cholangitis, cholelithiasis, fatty liver disease, hepatic amyloidosis, granulomatous hepatitis, drug-induced liver injury, venous thromboembolism, primary biliary cholangitis, IgG4-related cholangiopathy, autoimmune hepatitis, liver abscesses or the reactivation of viral hepatitis. The most common disease is primary sclerosing cholangitis, a condition diagnosed especially in patients with ulcerative colitis. The progress registered in recent years in the therapeutic management of IBD has not eliminated the risk of drug-induced liver disease. Additionally, the immunosuppression encountered in these patients increases the risk of opportunistic infections, including the reactivation of viral hepatitis. Currently, one of the concerns consists of establishing an efficiency and safety profile of the use of direct-acting antiviral agents (DAA) among patients with hepatitis C and IBD. Early diagnosis and optimal treatment of liver complications can improve the prognoses of these patients.
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3
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Park YJ, Woo HY, Kim MB, Ahn J, Heo J. Primary hepatic sarcoidosis presenting with cholestatic liver disease and mimicking primary biliary cholangitis. Yeungnam Univ J Med 2021; 39:256-261. [PMID: 34411476 PMCID: PMC9273146 DOI: 10.12701/yujm.2021.01151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 06/28/2021] [Indexed: 11/08/2022] Open
Abstract
Sarcoidosis often involves the liver. However, primary hepatic sarcoidosis confined to the liver without evidence of systemic involvement is rare. We report the case of a 37-year-old man with hepatic sarcoidosis who initially presented with elevated liver enzymes and suspicious cirrhotic nodules on computed tomography. The patient had cirrhosis but did not have portal hypertension. Based on the initial histopathologic finding of chronic granulomatous inflammation and the common clinical characteristics of sarcoidosis, he was initially diagnosed with primary biliary cholangitis, and his daily dosage of ursodeoxycholic acid was increased to 900 mg. After 14 months of treatment, his total serum bilirubin concentration was 10.9 mg/dL (upper normal limit, 1.2 mg/dL). Additionally, a transjugular liver biopsy revealed multiple noncaseating granulomas. He was diagnosed with primary hepatic sarcoidosis involving the lungs, heart, spleen, kidneys, and skin. Treatment with methylprednisolone was initiated. Two weeks later, he was started on azathioprine, and the dose of steroid was simultaneously reduced. These findings indicate the importance of including hepatic sarcoidosis as a possible diagnosis in patients with elevated liver enzymes or cryptogenic cirrhosis.
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Affiliation(s)
- Young Joo Park
- Department of Internal Medicine, Pusan National University Hospital, Busan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Hyun Young Woo
- Department of Internal Medicine, Pusan National University Hospital, Busan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Moon Bum Kim
- Department of Dermatology, Pusan National University Hospital, Busan, Korea
| | - Jihyun Ahn
- Department of Pathology, Pusan National University Hospital, Busan, Korea
| | - Jeong Heo
- Department of Internal Medicine, Pusan National University Hospital, Busan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
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4
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Kang K, Sun Y, Li YL, Chang B. Pathogenesis of liver injury in Takayasu arteritis: advanced understanding leads to new horizons. J Int Med Res 2020; 48:300060520972222. [PMID: 33275473 PMCID: PMC7720339 DOI: 10.1177/0300060520972222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Liver injury in Takayasu arteritis (TA) is a rare phenomenon. Most symptoms are nonspecific, and the exact pathogenesis remains to be elucidated. Early diagnosis and new treatment methods are important for an improved prognosis. A summary of the clinical information and mechanistic analyses may contribute to making an early diagnosis and development of new treatment methods. A PubMed search was conducted using the specific key words “Takayasu arteritis” and “liver” or “hepatitis” or “hepatic”. Symptoms and treatment of TA with an accompanying liver injury were reviewed retrospectively. Many factors are presumed to be involved in the mechanism of TA with liver injury, including the immune response, genes, infections, and gut microbiota. There are several lines of evidence indicating that immune dysfunction is the main pathogenic factor that triggers granuloma formation in TA patients. However, the role of genetics and infections has not been fully confirmed. Recently, the gut microbiota has emerged as an essential component in the process. We reviewed in detail the current concepts that support the complex pathogenesis of TA accompanied by liver injury, and we presented recent theories from the literature. Finally, we discussed future research directions of liver injury in TA.
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Affiliation(s)
- Kai Kang
- Department of Gastroenterology, First Affiliated Hospital, China Medical University, Shenyang, China
| | - Yue Sun
- Department of Gastroenterology, First Affiliated Hospital, China Medical University, Shenyang, China
| | - Yi Ling Li
- Department of Gastroenterology, First Affiliated Hospital, China Medical University, Shenyang, China
| | - Bing Chang
- Department of Gastroenterology, First Affiliated Hospital, China Medical University, Shenyang, China
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5
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Sun KD, Zhang YJ, Zhu LP, Yang B, Wang SY, Yu ZH, Zhang HC, Chen X. Abnormal serum carbohydrate antigen 19-9 levels in a patient with splenic retiform haemangioendothelioma concomitant with hepatic amyloidosis: A case report. World J Clin Cases 2020; 8:1108-1115. [PMID: 32258081 PMCID: PMC7103981 DOI: 10.12998/wjcc.v8.i6.1108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 01/21/2020] [Accepted: 03/14/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Carbohydrate antigen 19-9 (CA 19-9) is a glycoprotein that is used as a reliable tool for monitoring pancreatic cancer. Serum CA 19-9 levels are increased in patients suffering from liver, lung, and other non-malignant diseases. Haemangioendothelioma is a vascular neoplasm with a borderline biological behaviour. However, no case of haemangioendothelioma has yet been reported to be associated with CA 19-9.
CASE SUMMARY A 54-year-old Chinese man was referred to our hospital for discontinuous fatigue and unintentional weight loss for over one year. Laboratory investigations revealed an elevated serum CA 19-9 concentration of 39 IU/mL (reference interval, 0–37 IU/mL) over one year before admission. Afterwards, coagulopathy appeared, and the patient’s serum CA 19-9 concentration increased continuously. At the time of admission, abdominal pain and haemorrhagic shock burst occurred, and emergency medical operation was performed. Laboratory investigations conducted upon admission showed a serum CA19-9 concentration of 392.56 IU/mL. Surgical resection of the spleen was undertaken, and pathological examination showed retiform haemangioendothelioma. The patient developed jaundice ten days after surgical excision of the spleen. Pathological examination of needle biopsy samples of the liver yielded a diagnosis of hepatic amyloidosis.
CONCLUSION We describe a rare case of splenic retiform haemangioenthelioma concomitant with hepatic amyloidosis. Physicians should note abnormal serum CA 19-9 levels with early symptoms of fatigue and unintentional weight loss.
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Affiliation(s)
- Kai-Di Sun
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Yu-Jie Zhang
- Department of Pathology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Lan-Ping Zhu
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Bo Yang
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Sai-Yu Wang
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Zi-Han Yu
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Hai-Cheng Zhang
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Xin Chen
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin 300052, China
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6
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Giovannini M, Luzzati M, Ferrara G, Buccoliero AM, Simonini G, de Martino M, Cimaz R, Giani T. Common symptoms for a rare disease in a girl with sarcoidosis: a case report. Ital J Pediatr 2018; 44:74. [PMID: 29954416 PMCID: PMC6025712 DOI: 10.1186/s13052-018-0517-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 06/21/2018] [Indexed: 12/18/2022] Open
Abstract
Background Sarcoidosis in pediatric age is uncommon and challenging diagnosis, because manifestations can be significantly variable and non-specific since it is a multisystem disease, and virtually any organ system may be involved. Case presentation In this report, we describe the case of a 12-year-old girl presenting with fatigue and weight loss, with a painless hepato-splenomegaly without additional clinical signs on physical examination. In our patient, once we had ruled out infections, malignancies and granulomatous diseases of childhood, we made diagnosis of sarcoidosis, finding suggestive histological features in two different tissues (liver and lymph nodes) with lung involvement. Conclusions Our case points out that pediatricians should consider sarcoidosis in the differential diagnosis in case of systemic symptoms, even in absence of other specific clinical clues, because they represent the most common clinical manifestations on presentation in children, in order to refer promptly the young patient to specialist evaluation.
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Affiliation(s)
- Mattia Giovannini
- University of Florence, piazza di San Marco, 4, 50121, Florence, Italy
| | - Michele Luzzati
- University of Florence, piazza di San Marco, 4, 50121, Florence, Italy
| | - Giovanna Ferrara
- University of Trieste, via dell'Istria, 65/1, 34100, Trieste, Italy.
| | - Anna Maria Buccoliero
- Anatomic Pathology Unit, Meyer Children's University Hospital, viale Pieraccini, 24, 50139, Florence, Italy
| | - Gabriele Simonini
- University of Florence, piazza di San Marco, 4, 50121, Florence, Italy.,Anna Meyer Children's University Hospital, viale Pieraccini, 24, 50139, Florence, Italy
| | - Maurizio de Martino
- University of Florence, piazza di San Marco, 4, 50121, Florence, Italy.,Anna Meyer Children's University Hospital, viale Pieraccini, 24, 50139, Florence, Italy
| | - Rolando Cimaz
- University of Florence, piazza di San Marco, 4, 50121, Florence, Italy.,Anna Meyer Children's University Hospital, viale Pieraccini, 24, 50139, Florence, Italy
| | - Teresa Giani
- Anna Meyer Children's University Hospital, viale Pieraccini, 24, 50139, Florence, Italy
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7
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Fousekis FS, Theopistos VI, Katsanos KH, Tsianos EV, Christodoulou DK. Hepatobiliary Manifestations and Complications in Inflammatory Bowel Disease: A Review. Gastroenterology Res 2018; 11:83-94. [PMID: 29707074 PMCID: PMC5916631 DOI: 10.14740/gr990w] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 03/12/2018] [Indexed: 12/12/2022] Open
Abstract
Liver and biliary track diseases are common extraintestinal manifestations of inflammatory bowel disease (IBD), reported both in Crohn’s disease and ulcerative colitis, and may occur at any time during the natural course of the disease. Their etiology is mainly related to pathophysiological changes induced by IBD, and secondary, due to drugs used in IBD. Fatty liver is considered as the most frequent hepatobiliary manifestation in IBD, while primary sclerosing cholangitis (PSC) is the most correlated hepatobiliary disorder and is more prevalent in patients with ulcerative colitis. PSC can cause serious complications from the liver, biliary tree, and gallbladder and can lead to liver failure. Less frequently, IBD-associated hepatobiliary manifestations include cholelithiasis, granulomatous hepatitis, portal vein thrombosis, IgG4-related cholangiopathy, pyogenic liver abscess, hepatic amyloidosis and primary biliary cirrhosis. Most of the drugs used for IBD treatment may cause liver toxicity. Methotrexate and thiopurines carry the higher risk for hepatotoxicity, and in many cases, dose adjustment may normalize the liver biochemical tests. Reactivation of hepatitis B and C virus during immunosuppressive use, especially during use of biological agents, is a major concern, and adequate screening, vaccination and prophylactic treatment is warranted.
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Affiliation(s)
- Fotios S Fousekis
- Department of Gastroenterology and Hepatology, Medical School of Ioannina, Greece
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8
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Iqbal U, Siddiqui HU, Anwar H, Chaudhary A, Quadri AA. Allopurinol-Induced Granulomatous Hepatitis: A Case Report and Review of Literature. J Investig Med High Impact Case Rep 2017; 5:2324709617728302. [PMID: 29082266 PMCID: PMC5644365 DOI: 10.1177/2324709617728302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 07/29/2017] [Accepted: 08/04/2017] [Indexed: 11/16/2022] Open
Abstract
Liver enzyme elevation is a common reason for referral to a gastroenterologist. Drugs are one of the most common reasons for asymptomatic elevation of liver enzymes. We present here a case of granulomatous hepatitis (GH) secondary to long-term use of allopurinol. An 83-year-old male with a history of chronic gout and hypertension was evaluated for elevation of liver enzymes. He denies any complaints of abdominal pain, nausea, fever, chills, weight loss, night sweats, or yellowness of skin. He denies any use of herbal medications. He was on losartan and allopurinol for years. No new medications reported. Physical examination was unremarkable. Labs showed aspartate transaminase 101 U/L, alanine transaminase 81 U/L, and alkaline phosphatase 645 U/L. Ultrasound of the abdomen showed coarse liver texture. Liver biopsy was done that showed mixed GH. Given negative autoimmune and viral serologies, allopurinol-induced GH was suspected. Allopurinol was held, and repeat liver enzymes were checked in 3 months, which showed improvement in transaminase and alkaline phosphatase levels. This case highlights the importance of reviewing medications carefully when evaluating a patient with liver enzymes elevation, as stopping the offending drug can normalize the abnormalities in liver chemistries and can prevent subsequent expensive testing.
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Affiliation(s)
- Umair Iqbal
- Bassett Medical Center, Cooperstown, NY, USA
| | | | - Hafsa Anwar
- Dow University of Health and Sciences, Karachi, Pakistan
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9
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Chronic Hepatitis with Liver Granulomas in a Patient with Granuloma Annulare: A Case Report and Review of the Literature. Case Rep Gastrointest Med 2017; 2017:8768529. [PMID: 28326206 PMCID: PMC5343250 DOI: 10.1155/2017/8768529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 01/25/2017] [Accepted: 02/08/2017] [Indexed: 11/17/2022] Open
Abstract
Granuloma annulare (GA) is a benign granulomatous skin disorder of unknown etiology. GA is rarely associated with liver diseases. We report a unique case of chronic hepatitis with liver granulomas in a patient with GA. Despite an extensive workup, no clear etiology for the hepatitis was found. Based on the possible immune pathophysiology of GA and the presence of liver granulomas, the patient was treated with prednisone and azathioprine which resulted in complete normalization of the liver enzymes and concurrent improvement of GA. The association between liver diseases and GA is reviewed.
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10
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Affiliation(s)
- Rabih Geha
- From the Division of Gastroenterology (M.P.), Department of Medicine (R.G., M.P., G.D.), and the Department of Pathology (R.M.G.), University of California, San Francisco, and Medical Service, San Francisco Veterans Affairs Medical Center (G.D.) - both in San Francisco
| | - Marion Peters
- From the Division of Gastroenterology (M.P.), Department of Medicine (R.G., M.P., G.D.), and the Department of Pathology (R.M.G.), University of California, San Francisco, and Medical Service, San Francisco Veterans Affairs Medical Center (G.D.) - both in San Francisco
| | - Ryan M Gill
- From the Division of Gastroenterology (M.P.), Department of Medicine (R.G., M.P., G.D.), and the Department of Pathology (R.M.G.), University of California, San Francisco, and Medical Service, San Francisco Veterans Affairs Medical Center (G.D.) - both in San Francisco
| | - Gurpreet Dhaliwal
- From the Division of Gastroenterology (M.P.), Department of Medicine (R.G., M.P., G.D.), and the Department of Pathology (R.M.G.), University of California, San Francisco, and Medical Service, San Francisco Veterans Affairs Medical Center (G.D.) - both in San Francisco
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11
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Fetzer DT, Rees MA, Dasyam AK, Tublin ME. Hepatic sarcoidosis in patients presenting with liver dysfunction: imaging appearance, pathological correlation and disease evolution. Eur Radiol 2016; 26:3129-37. [DOI: 10.1007/s00330-015-4169-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 09/30/2015] [Accepted: 12/14/2015] [Indexed: 12/24/2022]
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12
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The Effector Protein BPE005 from Brucella abortus Induces Collagen Deposition and Matrix Metalloproteinase 9 Downmodulation via Transforming Growth Factor β1 in Hepatic Stellate Cells. Infect Immun 2015; 84:598-606. [PMID: 26667834 DOI: 10.1128/iai.01227-15] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 11/23/2015] [Indexed: 01/18/2023] Open
Abstract
The liver is frequently affected in patients with active brucellosis. In the present study, we identified a virulence factor involved in the modulation of hepatic stellate cell function and consequent fibrosis during Brucella abortus infection. This study assessed the role of BPE005 protein from B. abortus in the fibrotic phenotype induced on hepatic stellate cells during B. abortus infection in vitro and in vivo. We demonstrated that the fibrotic phenotype induced by B. abortus on hepatic stellate (LX-2) cells was dependent on BPE005, a protein associated with the type IV secretion system (T4SS) VirB from B. abortus. Our results indicated that B. abortus inhibits matrix metalloproteinase 9 (MMP-9) secretion through the activity of the BPE005-secreted protein and induces concomitant collagen deposition by LX-2 cells. BPE005 is a small protein containing a cyclic nucleotide monophosphate binding domain (cNMP) that modulates the LX-2 cell phenotype through a mechanism that is dependent on the cyclic AMP (cAMP)/protein kinase A (PKA) signaling pathway. Altogether, these results indicate that B. abortus tilts LX-2 cells to a profibrogenic phenotype employing a functional T4SS and the secreted BPE005 protein through a mechanism that involves the cAMP and PKA signaling pathway.
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13
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Rosenbaum JT, Choi D, Wilson DJ, Grossniklaus HE, Harrington CA, Sibley CH, Dailey RA, Ng JD, Steele EA, Czyz CN, Foster JA, Tse D, Alabiad C, Dubovy S, Parekh P, Harris GJ, Kazim M, Patel P, White V, Dolman P, Korn BS, Kikkawa D, Edward DP, Alkatan H, Al-Hussain H, Yeatts RP, Selva D, Stauffer P, Planck SR. Parallel Gene Expression Changes in Sarcoidosis Involving the Lacrimal Gland, Orbital Tissue, or Blood. JAMA Ophthalmol 2015; 133:770-7. [PMID: 25880323 DOI: 10.1001/jamaophthalmol.2015.0726] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
IMPORTANCE Sarcoidosis is a major cause of ocular or periocular inflammation. The pathogenesis of sarcoidosis is incompletely understood and diagnosis often requires a biopsy. OBJECTIVE To determine how gene expression in either orbital adipose tissue or the lacrimal gland affected by sarcoidosis compares with gene expression in other causes of orbital disease and how gene expression in tissue affected by sarcoidosis compares with gene expression in peripheral blood samples obtained from patients with sarcoidosis. DESIGN, SETTING, AND PARTICIPANTS In a multicenter, international, observational study, gene expression profiling of formalin-fixed biopsy specimens, using GeneChipp U133 Plus 2 microarrays (Affymetrix), was conducted between October 2012 and January 2014 on tissues biopsied from January 2000 through June 2013. Participants included 12 patients with orbital sarcoidosis (7 in adipose tissue; 5 affecting the lacrimal gland) as well as comparable tissue from 6 healthy individuals serving as controls or patients with thyroid eye disease, nonspecific orbital inflammation, or granulomatosis with polyangiitis. In addition, results were compared with gene expression in peripheral blood samples obtained from 12 historical individuals with sarcoidosis. MAIN OUTCOMES AND MEASURES Significantly differentially expressed transcripts defined as a minimum of a 1.5-fold increase or a comparable decrease and a false discovery rate of P < .05. RESULTS Signals from 2449 probe sets (transcripts from approximately 1522 genes) were significantly increased in the orbital adipose tissue from patients with sarcoidosis. Signals from 4050 probe sets (approximately 2619 genes) were significantly decreased. Signals from 3069 probe sets (approximately 2001 genes) were significantly higher and 3320 (approximately 2283 genes) were significantly lower in the lacrimal gland for patients with sarcoidosis. Ninety-two probe sets (approximately 69 genes) had significantly elevated signals and 67 probe sets (approximately 56 genes) had significantly lower signals in both orbital tissues and in peripheral blood from patients with sarcoidosis. The transcription factors, interferon-response factor 1, interferon-response factor 2, and nuclear factor κB, were strongly implicated in the expression of messenger RNA upregulated in common in the 3 tissues. CONCLUSIONS AND RELEVANCE Gene expression in sarcoidosis involving the orbit or lacrimal gland can be distinguished from gene expression patterns in control tissue and overlaps with many transcripts upregulated or downregulated in the peripheral blood of patients with sarcoidosis. These observations suggest that common pathogenic mechanisms contribute to sarcoidosis in different sites. The observations support the hypothesis that a pattern of gene expression profiles could provide diagnostic information in patients with sarcoidosis.
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Affiliation(s)
- James T Rosenbaum
- Casey Eye Institute, Oregon Health & Science University, Portland2Department of Medicine, School of Medicine, Oregon Health & Science University, Portland3Devers Eye Institute, Legacy Health Systems, Portland, Oregon
| | - Dongseok Choi
- Casey Eye Institute, Oregon Health & Science University, Portland4Department of Public Health and Preventive Medicine, School of Medicine, Oregon Health & Science University, Portland
| | - David J Wilson
- Casey Eye Institute, Oregon Health & Science University, Portland
| | - Hans E Grossniklaus
- Department of Ophthalmology, Emory School of Medicine, Emory University, Atlanta, Georgia
| | | | - Cailin H Sibley
- Department of Medicine, School of Medicine, Oregon Health & Science University, Portland
| | - Roger A Dailey
- Casey Eye Institute, Oregon Health & Science University, Portland
| | - John D Ng
- Casey Eye Institute, Oregon Health & Science University, Portland
| | - Eric A Steele
- Casey Eye Institute, Oregon Health & Science University, Portland
| | - Craig N Czyz
- Division of Ophthalmology, Ohio University, Athens
| | - Jill A Foster
- Department of Ophthalmology, College of Medicine and Public Health, The Ohio State University, Columbus
| | - David Tse
- Department of Ophthalmology, Miller School of Medicine, University of Miami, Miami, Florida
| | - Chris Alabiad
- Department of Ophthalmology, Miller School of Medicine, University of Miami, Miami, Florida
| | - Sander Dubovy
- Department of Ophthalmology, Miller School of Medicine, University of Miami, Miami, Florida
| | - Prashant Parekh
- Department of Ophthalmology, Miller School of Medicine, University of Miami, Miami, Florida
| | - Gerald J Harris
- Department of Ophthalmology, Medical College of Wisconsin, Milwaukee
| | - Michael Kazim
- Department of Ophthalmology, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Payal Patel
- Department of Ophthalmology, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Valerie White
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter Dolman
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bobby S Korn
- Department of Ophthalmology, School of Medicine, University of California, San Diego
| | - Don Kikkawa
- Department of Ophthalmology, School of Medicine, University of California, San Diego
| | - Deepak P Edward
- Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Hind Alkatan
- Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Hailah Al-Hussain
- Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - R Patrick Yeatts
- Department of Ophthalmology, School of Medicine, Wake Forrest University, Winston-Salem, North Carolina
| | - Dinesh Selva
- Ophthalmology Network, Royal Adelaide Hospital, Adelaide, Australia
| | - Patrick Stauffer
- Casey Eye Institute, Oregon Health & Science University, Portland
| | - Stephen R Planck
- Casey Eye Institute, Oregon Health & Science University, Portland2Department of Medicine, School of Medicine, Oregon Health & Science University, Portland3Devers Eye Institute, Legacy Health Systems, Portland, Oregon
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14
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Stelzer T, Kohler S, Marques Maggio E, Heuss LT. An unusual cause of febrile hepatitis. BMJ Case Rep 2015; 2015:bcr-2014-205857. [PMID: 26113581 DOI: 10.1136/bcr-2014-205857] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
We describe the case of a 51-year-old man with recently diagnosed ulcerative colitis who developed fever and elevated liver enzymes as well as cholestasis a few weeks after starting treatment with mesalazine. As no obvious cause was found and fever persisted, liver biopsy was performed and revealed granulomatous hepatitis. The patient recovered completely after cessation of mesalazine, so that a drug-induced granulomatous hepatitis after exclusion of other differential diagnoses in an extensive work up was assumed. The present case demonstrates that even though drug-induced liver injury due to mesalazine is rare, it should be considered in unclear cases and lead to prompt discontinuation of mesalazine.
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Affiliation(s)
- Teresa Stelzer
- Department of Internal Medicine, Spital Zollikerberg, Zollikerberg, Switzerland
| | - Sibylle Kohler
- Department of Endocrinology, University Hospital Zurich, Zurich, Switzerland
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Modaresi Esfeh J, Culver D, Plesec T, John B. Clinical presentation and protocol for management of hepatic sarcoidosis. Expert Rev Gastroenterol Hepatol 2015; 9:349-58. [PMID: 25473783 DOI: 10.1586/17474124.2015.958468] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The liver is one of the most commonly involved extrapulmonary sites in sarcoidosis. Hepatic sarcoidosis has a broad range of presentations from scattered, asymptomatic noncaseating granulomas with normal liver enzymes, which are very common in patients with known pulmonary sarcoidosis, to portal hypertension and cirrhosis, which are relatively uncommon. Diagnosis is based on a combination of clinical, laboratory and histological manifestations. The authors' protocol for management of patients with suspected sarcoidosis of the liver without focal lesions includes a transjugular liver biopsy with portal pressure measurements to confirm the diagnosis, rule out coexisting liver diseases and to identify select patients with fibrosis or portal hypertension for consideration of immunosuppression. Steroids and azathioprine are the preferred agents and methotrexate is not recommended.
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16
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Rossi RE, Girelli CM, Bernasconi G, Conte D. Currently neglected, physical examination maintains its clinical relevance. Intern Emerg Med 2014; 9:871-4. [PMID: 25253634 DOI: 10.1007/s11739-014-1132-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 09/11/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Roberta Elisa Rossi
- Gastroenterology and Endoscopy Unit-Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Department of Pathophysiology and Transplantation, Universita` degli Studi di Milano, Milan, Italy,
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17
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Sarcoidosis Presenting as Necrotizing Sarcoid Granulomatosis of the Liver, Sclerosing Cholangitis, and Gastric Ulcer. ACG Case Rep J 2014; 1:164-6. [PMID: 26157862 PMCID: PMC4435308 DOI: 10.14309/crj.2014.38] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 03/18/2014] [Indexed: 11/17/2022] Open
Abstract
Sarcoidosis is a multisystem granulomatous disease. The liver is affected in up to 50-90% of cases. Sarcoidosis typically presents as non-necrotizing epithelioid granuloma. The occurrence of non-infective necrotizing sarcoid granuloma (NSG) is infrequent, and the finding of NSG in the liver is rare. We report a case of NSG of the liver and lymph nodes, granulomatous gastric ulcer, and secondary cholangitis coexisting in a patient. We discuss the clinical features of the case and briefly review NSG. There is only 1 previously reported case of NSG of the liver in literature.
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18
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Abstract
Drug-induced hepatotoxicity is underrecognized but increasingly identified as causing acute and chronic liver disease. Several prescription drugs, over-the-counter medications, dietary and/or supplementary agents, and herbal products are hepatotoxic. Drug-induced liver injury mimics other primary acute and chronic liver diseases and it should be considered in patients with hepatobiliary disease. Certain drugs result in specific histopathologic patterns of liver injury, which may help in sorting out the responsible drug. The diagnosis of drug-induced hepatotoxicity is challenging. It involves excluding other possible causes, careful medication history, the latent period between drug exposure and symptom onset and/or abnormal liver tests, and histopathologic findings.
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Affiliation(s)
- Xuchen Zhang
- Department of Pathology, VA Connecticut Health System and Yale University School of Medicine, 310 Cedar Street, LH 108, New Haven, CT 06516, USA.
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19
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Arriola Benitez PC, Scian R, Comerci DJ, Serantes DR, Vanzulli S, Fossati CA, Giambartolomei GH, Delpino MV. Brucella abortus induces collagen deposition and MMP-9 down-modulation in hepatic stellate cells via TGF-β1 production. THE AMERICAN JOURNAL OF PATHOLOGY 2013; 183:1918-1927. [PMID: 24113459 DOI: 10.1016/j.ajpath.2013.08.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 08/02/2013] [Accepted: 08/12/2013] [Indexed: 01/18/2023]
Abstract
In patients with active brucellosis, the liver is frequently affected by histopathologic lesions, such as granulomas, inflammatory infiltrations, and parenchymal necrosis. Herein, we examine some potential mechanisms of liver damage in brucellosis. We demonstrate that Brucella abortus infection inhibits matrix metalloproteinase-9 (MMP-9) secretion and induces collagen deposition and tissue inhibitor of matrix metalloproteinase-1 secretion induced by hepatic stellate cells (LX-2). These phenomena depend on transforming growth factor-β1 induction. In contrast, supernatants from B. abortus-infected hepatocytes and monocytes induce MMP-9 secretion and inhibit collagen deposition in hepatic stellate cells. Yet, if LX-2 cells are infected with B. abortus, the capacity of supernatants from B. abortus-infected hepatocytes and monocytes to induce MMP-9 secretion and inhibit collagen deposition is abrogated. These results indicate that depending on the balance between interacting cells and cytokines of the surrounding milieu, the response of LX-2 cells could be turned into an inflammatory or fibrogenic phenotype. Livers from mice infected with B. abortus displayed a fibrogenic phenotype with patches of collagen deposition and transforming growth factor-β1 induction. This study provides potential mechanisms of liver immune response induced by B. abortus-infected hepatic stellate cells. In addition, these results demonstrate that the cross talk of these cells with hepatocytes and macrophages implements a series of interactions that may contribute to explaining some of mechanisms of liver damage observed in human brucellosis.
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Affiliation(s)
- Paula C Arriola Benitez
- Institute of Immunology, Genetics, and Metabolism, Jose de San Martin Clinical Hospital, Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Romina Scian
- Institute of Immunology, Genetics, and Metabolism, Jose de San Martin Clinical Hospital, Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Diego J Comerci
- Biotechnology Research Institute, Technology Institute of Chascomús, National University of San Martin National Scientific and Technical Research, Buenos Aires, Argentina
| | - Diego Rey Serantes
- Biotechnology Research Institute, Technology Institute of Chascomús, National University of San Martin National Scientific and Technical Research, Buenos Aires, Argentina
| | - Silvia Vanzulli
- Institute of Experimental Medicine, National Academy of Medicine, Buenos Aires, Argentina
| | - Carlos A Fossati
- Institute for the Study of Humoral Immunity, Faculty of Pharmacy and Biochemistry, University of Buenos Aires, Buenos Aires, Argentina; Laboratory of Immune System Research, Faculty of Exact Sciences, National University of La Plata, La Plata, Argentina
| | - Guillermo H Giambartolomei
- Institute of Immunology, Genetics, and Metabolism, Jose de San Martin Clinical Hospital, Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - M Victoria Delpino
- Institute of Immunology, Genetics, and Metabolism, Jose de San Martin Clinical Hospital, Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina.
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20
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Fallahzadeh MK, Fallahzadeh MA, Mojtahedi Y, Dehghani SM, Shorafa E, Basiratnia M, Geramizadeh B, Fallahzadeh MH. Granulomatous liver involvement in a child with systemic lupus erythematosus: a case report and review of the literature. Lupus 2013; 22:1388-93. [PMID: 24003081 DOI: 10.1177/0961203313504146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Systemic lupus erythematosus (SLE) is uncommon in young children and unusual in infancy. Although a variety of liver pathologies have been reported in SLE, presentation of this disease with granulomatous liver involvement is very rare. In this article, for the first time, we report an infant girl presenting with unexplained hepatosplenomegaly and non-necrotizing granulomatous liver involvement at the age of six months who later developed pancytopenia and proteinuria and was finally diagnosed with SLE at the age of three years. Therefore, we suggest that SLE could be considered as one of the possible differential diagnoses when infants or children present with unexplained granulomatous liver involvement.
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Affiliation(s)
- M K Fallahzadeh
- 1Department of Pediatrics, Shiraz University of Medical Sciences, Iran
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21
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Enweluzo C, Sharma A, Lenfest S, Aziz F. Non-Tuberculous Mycobacterium: A Rare Cause of Granulomatous Hepatitis. Gastroenterology Res 2013; 6:71-73. [PMID: 27785230 PMCID: PMC5051161 DOI: 10.4021/gr538w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/19/2013] [Indexed: 11/23/2022] Open
Abstract
Granulomatous hepatitis is a syndrome usually characterized by fever of unknown origin, myalgias, hepatosplenomegaly, and arthralgias, right upper quadrant abdominal pain or tenderness, with or without an elevation in serum transaminases. In this article, we outline our experience with a 64-year-old male presenting with a 3.5 weeks history of fever of unknown origin, night sweats, extreme fatigue and a 20 lb. weight loss. He had an extensive evaluation including 2 liver biopsies that was indicative of fibrin ring granulomas and a positive PCR for Mycobacterium chelonae-abscessus. He was eventually treated empirically with antibiotics that led to an improvement of his symptoms.
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Affiliation(s)
- Chijioke Enweluzo
- Section on Hospital Medicine, Department of Internal Medicine, Wake Forest Baptist University Medical Center, Medical Center Boulevard, Winston Salem, NC 27101, USA
| | - Anuradha Sharma
- Section on Infectious Diseases, Department of Internal Medicine, Wake Forest Baptist University Medical Center, Medical Center Boulevard, Winston Salem, NC 27101, USA
| | - Stephen Lenfest
- Department of Pathology, Wake Forest Baptist University Medical Center, Medical Center Boulevard, Winston Salem, NC 27101, USA
| | - Fahad Aziz
- Section on Hospital Medicine, Department of Internal Medicine, Wake Forest Baptist University Medical Center, Medical Center Boulevard, Winston Salem, NC 27101, USA
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