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Xu YX, Niu XX, Xu BL, Ji Y, Yao QY. Diagnosis and management of benign recurrent intrahepatic cholestasis and psychosocial stressors in an adolescent: A case report. World J Clin Cases 2024; 12:4427-4433. [PMID: 39015910 PMCID: PMC11235557 DOI: 10.12998/wjcc.v12.i20.4427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 05/14/2024] [Accepted: 05/22/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND Benign recurrent intrahepatic cholestasis (BRIC) is a rare autosomal recessive disorder, characterized by episodes of intense pruritus, elevated serum levels of alkaline phosphatase and bilirubin, and near-normal -glutamyl transferase. These episodes may persist for weeks to months before spontaneously resolving, with patients typically remaining asymptomatic between occurrences. Diagnosis entails the evaluation of clinical symptoms and targeted genetic testing. Although BRIC is recognized as a benign genetic disorder, the triggers, particularly psychosocial factors, remain poorly understood. CASE SUMMARY An 18-year-old Chinese man presented with recurrent jaundice and pruritus after a cold, which was exacerbated by self-medication involving vitamin B and paracetamol. Clinical and laboratory evaluations revealed elevated levels of bilirubin and liver enzymes, in the absence of viral or autoimmune liver disease. Imaging excluded biliary and pancreatic abnormalities, and liver biopsy demonstrated centrilobular cholestasis, culminating in a BRIC diagnosis confirmed by the identification of a novel ATP8B1 gene mutation. Psychological assessment of the patient unveiled stress attributable to academic and familial pressures, regarded as potential triggers for BRIC. Initial relief was observed with ursodeoxycholic acid and cetirizine, followed by an adjustment of the treatment regimen in response to elevated liver enzymes. The patient's condition significantly improved following a stress-related episode, thanks to a comprehensive management approach that included psychosocial support and medical treatment. CONCLUSION Our research highlights genetic and psychosocial influences on BRIC, emphasizing integrated diagnostic and management strategies.
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Affiliation(s)
- Ya-Xin Xu
- Department of General Practice, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Xiao-Xuan Niu
- Department of Nutrition, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Bei-Li Xu
- Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yuan Ji
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Qun-Yan Yao
- Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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Çalhan T, Yivli E. Coronavirus disease 2019 (COVID-19) as a potential trigger for benign recurrent intrahepatic cholestasis. Clin Case Rep 2022; 10:e05557. [PMID: 35310310 PMCID: PMC8908081 DOI: 10.1002/ccr3.5557] [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: 10/15/2021] [Revised: 12/21/2021] [Accepted: 01/14/2022] [Indexed: 11/11/2022] Open
Abstract
Benign recurrent intrahepatic cholestasis (BRIC) is a rare disease characterized by recurrent severe itching and jaundice. Coronavirus disease 2019 (COVID-19) is a multisystemic acute viral disease and the liver is frequently affected. Here, we wanted to present a BRIC case triggered by COVID-19 infection, discussing it together with current information.
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Affiliation(s)
- Turan Çalhan
- Department of GastroenterologyHaseki Training and Research HospitalIstanbulTurkey
| | - Elif Yivli
- Department of GastroenterologyHaseki Training and Research HospitalIstanbulTurkey
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Benign Recurrent Intrahepatic Cholestasis in Pregnancy: Fetal Death at 36 Weeks of Gestation. Case Rep Obstet Gynecol 2021; 2021:5086846. [PMID: 34532146 PMCID: PMC8440103 DOI: 10.1155/2021/5086846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 08/26/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Benign recurrent intrahepatic cholestasis is a rare hepatologic disorder characterized by recurrent, self-limited episodes of severe pruritus, jaundice, and elevated bile acids. While there are guidelines for the management of intrahepatic cholestasis of pregnancy, the literature regarding benign recurrent intrahepatic cholestasis and pregnancy is limited. Case A 29-year-old G1P0 woman, with history of liver toxicity, had elevated total serum bile acid levels and liver enzymes documented at 8 weeks of gestation and throughout her pregnancy. She had a reactive nonstress test just 3 days prior to her induction. Fetal demise was noted when she presented at 36 weeks for her induction. Conclusion We recommend that women with elevated total serum bile acid early in pregnancy due to a separate entity relative to intrahepatic cholestasis of pregnancy be managed in a more individualized approach.
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Choudhury A, Kulkarni AV, Sahoo B, Bihari C. Endoscopic nasobiliary drainage: an effective treatment option for benign recurrent intrahepatic cholestasis (BRIC). BMJ Case Rep 2017; 2017:bcr-2016-218874. [PMID: 28476903 DOI: 10.1136/bcr-2016-218874] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Benign recurrent intrahepatic cholestasis (BRIC) is characterised by recurrent episodes of jaundice, severe pruritus and low or normal serum γ-glutamyltransferase activity lasting from several weeks to months. BRIC is an autosomal recessive disorder caused by the mutation in either of the two hepatic transporter genes-ATP8B1 or ABCB11 gene. The disease is very well known for episodic flare of jaundice with cholestatic symptoms that are spontaneous or perpetuated by acute insults, followed by self-recovery. There is no proven medical therapy and rarely does it progress to progressive familial intrahepatic cholestasis (PFIC) or biliary cirrhosis. BRIC may be associated with nephrolithiasis, diabetes or pancreatitis. Here, we report a case of BRIC with spontaneous flare and further complicated by drug-induced liver injury with disabling cholestastic symptoms, who underwent endoscopic nasobiliary drainage and was completely relieved of the distressing symptoms.
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Affiliation(s)
- Ashok Choudhury
- Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Anand V Kulkarni
- Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Bishnupriya Sahoo
- Pediatrics, Shree Guru Gobind Singh Tricentenary University Faculty of Medicine and Health Sciences, Gurgaon, India
| | - Chhagan Bihari
- Institute of Liver and Biliary Sciences, New Delhi, India
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Tai Y, Xie Y, Tang CW. Compound heterozygous mutations of ABCB11 responsible for benign recurrent intrahepatic cholestasis. J Dig Dis 2015; 16:299-302. [PMID: 25565657 DOI: 10.1111/1751-2980.12227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Yang Tai
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Yan Xie
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Cheng Wei Tang
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
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Wakui N, Fujita M, Oba N, Yamauchi Y, Takeda Y, Ueki N, Otsuka T, Nishinakagawa S, Shiono S, Kojima T. Endoscopic nasobiliary drainage improves jaundice attack symptoms in benign recurrent intrahepatic cholestasis: A case report. Exp Ther Med 2012; 5:389-394. [PMID: 23403701 PMCID: PMC3570127 DOI: 10.3892/etm.2012.814] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2012] [Accepted: 11/13/2012] [Indexed: 11/15/2022] Open
Abstract
A 66-year-old male with unbearable pruritus and jaundice was admitted for detailed examination. Blood tests on admission showed increased bilirubin with a dominant direct fraction. Ultrasonography and computed tomography performed subsequent to admission showed no narrowing or distension of the bile ducts. As the jaundice symptoms were not improved by the oral administration of ursodeoxycholic acid (300 mg/day) that had been started immediately after admission, endoscopic retrograde cholangiopancreatography (ERCP) was performed on hospital day 14. This also showed no abnormalities of the bile ducts. After considerating its potential effects for improving jaundice, endoscopic nasobiliary drainage (ENBD) was performed on the same day and was followed by immediate improvements in pruritus and jaundice. Detailed examinations were performed to identify the cause of the jaundice, which was suspected to be viral hepatitis, autoimmune hepatitis or drug-induced liver injury, however, there were no findings suggestive of any of these conditions. Following a further increase in bilirubin levels, confirmed by additional blood tests, a liver biopsy was performed. Histological findings were consistent with the histological features of benign recurrent intrahepatic cholestasis (BRIC). Although ursodeoxycholic acid is used as a first-line treatment in most cases of BRIC, ENBD should also be considered for patients not responding to this treatment.
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Affiliation(s)
- Noritaka Wakui
- Departments of Internal Gastroenterology, Tokyo Rosai Hospital, Tokyo 143-0013, Japan
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Walensi M, Canbay A, Witzke O, Gerken G, Kahraman A. Long-term therapy of a patient with summerskill-walshe-tygstrup syndrome by applying prometheus® liver dialysis: a case report. Case Rep Gastroenterol 2012; 6:550-6. [PMID: 22949896 PMCID: PMC3433004 DOI: 10.1159/000342348] [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] [Indexed: 01/28/2023] Open
Abstract
Summerskill-Walshe-Tygstrup syndrome is a rare benign chronic liver disease characterized by recurring cholestasis with jaundice and severe pruritus. Due to insufficient conservative treatment, liver dialysis by Prometheus® was applied to a 45-year-old female patient with resistant pruritus. Initially, other possible liver diseases were excluded and the patient was treated symptomatically since the diagnosis of Summerskill-Walshe-Tygstrup was stated in 1998. As conservative and endoscopic methods progressively failed to relieve the patient's suffering, Prometheus® liver dialysis was performed regularly since 2006 at 3-month intervals and successfully led to a decrease in the patient's symptoms. Cholestatic liver enzymes and also serum bile acids could be lowered significantly from an average of 22.5 ± 2.7 to 7.3 ± 1.7 µmol/l. Consequently, Prometheus® liver dialysis may be a beneficial option for patients with benign recurrent intrahepatic cholestasis suffering from therapy-resistant symptoms and may be used as well as other extracorporeal liver support devices which have already been reported to improve cholestatic pruritus.
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Affiliation(s)
- Mikolaj Walensi
- Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany
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Folvik G, Hilde O, Helge GO. Benign recurrent intrahepatic cholestasis: review and long-term follow-up of five cases. Scand J Gastroenterol 2012; 47:482-8. [PMID: 22229830 DOI: 10.3109/00365521.2011.650191] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Benign recurrent intrahepatic cholestasis (BRIC) is a rare autosomal recessive inherited disorder characterized by intermittent episodes of cholestatic jaundice. For the patients, the disease is a physical and psychological challenge. There is no curable treatment, but symptomatic relief is described following treatment with rifampicin or plasmapheresis. MATERIAL AND METHODS Five patients suffering from BRIC followed up for 17 years by one consultant are described. Two patients were treated with rifampicin and plasmapheresis, two with rifampicin alone, and one with plasmapheresis. RESULTS The treatments showed symptomatic relief, effect on biochemical parameters, and earlier clinical remission compared with no treatment or treatment with other substances like cholestyramine, antihistamines, and ursodeoxycholic acid. CONCLUSIONS Both rifampicin and plasmapheresis represent important therapeutic options of acute cholestatic attacks in patients with BRIC. As a noninvasive treatment, rifampicin may be the first choice.
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Affiliation(s)
- Geir Folvik
- Department of Medicine, Division of Gastroenterology, Haukeland University Hospital and Institute of Medicine, University of Bergen, Bergen, Norway.
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Harris MJ, Le Couteur DG, Arias IM. Progressive familial intrahepatic cholestasis: genetic disorders of biliary transporters. J Gastroenterol Hepatol 2005; 20:807-17. [PMID: 15946126 DOI: 10.1111/j.1440-1746.2005.03743.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Progressive familial intrahepatic cholestasis types 1, 2 and 3 are childhood diseases of the liver. Benign recurrent intrahepatic cholestasis is predominantly an adult form with similar clinical symptoms that spontaneously resolve. These genetic disorders have significantly helped to unravel the basic mechanisms of the canalicular bile transport processes. Progressive familial intrahepatic cholestasis type 1 involves a gene also linked to benign recurrent intrahepatic cholestasis. The gene codes for an aminophospholipid translocase protein that maintains the integrity of the membrane. How a mutation in this protein causes cholestasis is unknown but is thought to involve the enterohepatic recirculation of bile acids. Progressive familial intrahepatic cholestasis types 2 and 3 involve the canalicular bile salt export pump and a phospholipid translocase, respectively, both of which are fundamental to bile secretion. This review covers the clinical manifestations, genetics, treatment and mechanism of each disease.
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Affiliation(s)
- Matthew J Harris
- ANZAC Research Institute, University of Sydney and Center for Education and Research on Aging, Concord Repatriation General Hospital, Sydney, NSW, Australia
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Abstract
Benign recurrent intrahepatic cholestasis is a rare autosomal recessive disorder characterized by repeated episodes of intense pruritus, profound elevations in serum alkaline phosphatase and bilirubin, with normal or nearly normal values for serum gamma-glutamyl transferase. Attack lasts from several weeks to months and resolve spontaneously. Between attacks patients remain asymptomatic for months to years. The disorder does not lead to progressive liver injury and is not fatal. Genetic studies have demonstrated that the disorder is the result of a mutation in ATP8BI, a gene that codes for the FIC1 (familial intrahepatic cholestasis) protein, which is also affected in other forms of familial intrahepatic cholestasis. It is believed this protein plays a role in bile acid secretion, in aminophospholid transport, and in maintaining fluidity of the cell membrane. Therapy is supportive and aimed at relieving pruritus and other complications of severe cholestasis until the episode resolves spontaneously.
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Affiliation(s)
- Velimir A Luketic
- Hepatology Section, Virginia Commonwealth University Health System, West Hospital, 14th Floor, 1200 East Broad Street, Richmond, VA 23219, USA
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12
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Abstract
A wide range of cholestatic liver diseases result from various primary defects in bile formation. Clinical features include jaundice, pruritus, failure to thrive, fat malabsorption, cholelithiasis, and variably progressive cirrhosis. Accurate diagnosis of these disorders is essential for determination of prognosis and selection of the most appropriate therapies. Severe genetic defects in canalicular bile acid and phospholipid excretion lead to progressive liver disease that often requires liver transplantation. Defects in bile acid biosynthesis and aminophospholipid transport may be responsive to medical or non-transplant surgical approaches.
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Affiliation(s)
- Gitit Tomer
- Division of Pediatric Gastroenetrology, One Gustave L. Levy Place, Box 1656, Mount Sinai Medical Center, New York, NY 10029, USA
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Parolin MB, Langowiski AR, Ioshii SO, Maggio EM, Coelho JC. [Benign recurrent intrahepatic cholestasis: a seven-year follow-up report]. ARQUIVOS DE GASTROENTEROLOGIA 2000; 37:231-4. [PMID: 11460604 DOI: 10.1590/s0004-28032000000400009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Benign recurrent intrahepatic cholestasis is a rare autosomal recessive disorder characterized by repeated episodes of intense pruritus and jaundice. Patients are completely asymptomatic for months to years between symptomatic periods. We report a case of a patient with a 7-year history of benign recurrent intrahepatic cholestasis. During the follow-up period the patient has suffered three attacks of cholestasis, confirmed by biochemical tests and histological exam. Liver enzymes were normal between the cholestasis episodes. Despite multiple attacks of cholestasis, no permanent liver damage has occurred. Although the diagnosis of benign recurrent intrahepatic cholestasis is rare, it should be included in the evaluation of a patient with cholestasis. The patients should be reassured of the benign course of this disorder.
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Affiliation(s)
- M B Parolin
- Serviço de Transplante Hepático, Hospital de Clínicas da Universidade Federal do Paraná-UFPR, Curitiba, PR
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Abstract
Benign recurrent intrahepatic cholestasis is a rare autosomal recessive disorder characterized by repeated episodes of intense pruritus and jaundice. Each attack lasts from several weeks to months before resolving spontaneously. Patients are completely asymptomatic for months to years between symptomatic periods. The disorder does not lead to progressive liver disease. Although attacks seem to be associated with a viral prodrome, an inciting viral agent or toxin has not been defined. Genetic studies have mapped the defect of this disorder to the long arm of chromosome 18 and a gene that codes for a P-type ATPase, which appears to be involved in aminophospholipid transport. Therapy during symptomatic periods is supportive and aimed at relief of severe pruritus until the episode resolves spontaneously.
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Affiliation(s)
- V A Luketic
- Department of Medicine, Hepatology Section, Medical College of Virginia Commonwealth University, Richmond, Virginia, USA
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Tygstrup N, Steig BA, Juijn JA, Bull LN, Houwen RH. Recurrent familial intrahepatic cholestasis in the Faeroe Islands. Phenotypic heterogeneity but genetic homogeneity. Hepatology 1999; 29:506-8. [PMID: 9918928 DOI: 10.1002/hep.510290214] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Recurrent familial intrahepatic cholestasis is an autosomal recessive disorder characterized by episodes of severe pruritus and jaundice lasting for weeks to months without extrahepatic bile duct obstruction. Symptom-free intervals may last for months to years, and chronic liver damage does not develop. We recently studied four of the five patients from the Faeroe Islands described by us 30 years ago (one had recently died) and an additional five patients that were identified after the initial report. The episodes of cholestasis were more frequent and severe in patients with early onset, but tended to reduce in frequency with age. The youngest patient, aged 25 years, who had had 16 episodes each lasting about 6 months, had a liver transplant after which no further episodes were recorded (1 year after surgery). Signs of chronic liver disease were absent in all patients. The FIC1 gene was investigated for mutations in the surviving patients. A single mutation (I661T) was found on both chromosomes in all nine patients, indicating that they are genetically identical for the disease-causing defect. Nevertheless, considerable differences among patients were observed clinically.
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Cançado EL, Leitão RM, Carrilho FJ, Laudanna AA. Unexpected clinical remission of cholestasis after rifampicin therapy in patients with normal or slightly increased levels of gamma-glutamyl transpeptidase. Am J Gastroenterol 1998; 93:1510-7. [PMID: 9732934 DOI: 10.1111/j.1572-0241.1998.00472.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Rifampicin is an effective drug against pruritus in intrahepatic cholestasis. However, there is no specific hepatic disease in which its use could cause undoubtedly biochemical improvement. The aim of this study was to describe patients with complete remission of cholestatic symptoms after rifampicin therapy. METHODS We reported three female patients with intrahepatic cholestasis with no evidence of viral, metabolic, or autoimmune liver diseases. Total bilirubin levels ranged from 13.2 to 27.2 mg/dl (before the first treatment with rifampicin), and in all of them gamma-glutamyl transpeptidase values were within the normal range or slightly increased. Rifampicin therapy was administered orally, without any concomitant drug, with an effective dosage of 5-17 mg/kg/day. RESULTS In all patients, pruritus ceased completely and bilirubin returned to normal values. The symptoms recurred after rifampicin withdrawal on, at least, three occasions in each patient, and these symptoms were always eliminated after its reintroduction. The patients had a total of 16 cholestatic episodes during a follow-up of 8 yr, with a complete clinical recovery in all of them. Undergoing therapy with a suitable dosage of rifampicin, none of the patients had a cholestatic crisis even during a period for as long as 12 months. The diagnosis of two patients was consistent with benign recurrent intrahepatic cholestasis, and it was not well defined in the remaining. CONCLUSION Rifampicin may induce clinical remission, and perhaps prevent clinical relapses of intrahepatic cholestasis with normal or slightly increased levels of gamma-glutamyl transpeptidase.
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Affiliation(s)
- E L Cançado
- Department of Gastroenterology, University of São Paulo School of Medicine, Brazil
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Balsells F, Wyllie R, Steffen R, Kay M. Benign recurrent intrahepatic cholestasis: improvement of pruritus and shortening of the symptomatic phase with rifampin therapy: a case report. Clin Pediatr (Phila) 1997; 36:483-5. [PMID: 9272324 DOI: 10.1177/000992289703600809] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- F Balsells
- Section of Pediatric Gastroenterology and Nutrition, Cleveland Clinic Foundation, Ohio 44195, USA
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De Koning TJ, Sandkuijl LA, De Schryver JE, Hennekam EA, Beemer FA, Houwen RH. Autosomal-recessive inheritance of benign recurrent intrahepatic cholestasis. AMERICAN JOURNAL OF MEDICAL GENETICS 1995; 57:479-82. [PMID: 7677155 DOI: 10.1002/ajmg.1320570324] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Benign recurrent intrahepatic cholestasis (BRIC) is a rare disorder characterized by recurrent episodes of cholestasis without permanent liver damage. Familial and sporadic cases have been described. Based on existing evidence, both autosomal-recessive and autosomal-dominant inheritance have been considered. We describe a large Dutch pedigree with 4 patients, strongly suggesting autosomal-recessive inheritance.
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Affiliation(s)
- T J De Koning
- Department of Pediatric Gastroenterology, Wilhelmina Children's Hospital, Utrecht, The Netherlands
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Putterman C, Keidar S, Brook JG. Benign recurrent intrahepatic cholestasis--25 years of follow-up. Postgrad Med J 1987; 63:295-6. [PMID: 3684838 PMCID: PMC2428157 DOI: 10.1136/pgmj.63.738.295] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Only 70 cases of recurrent intrahepatic cholestasis have been reported in the literature since the original description of this entity in 1959. The benign nature of the disease has been questioned, some authors suggesting progression to biliary cirrhosis. We report our follow-up of one such patient for over 25 years with no adverse physical consequences or histological deterioration. Sequential liver biopsies were obtained during this period. A conservative approach to diagnosis and treatment is therefore indicated.
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Affiliation(s)
- C Putterman
- Department of Internal Medicine D, Rambam Medical Center, Haifa, Israel
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Lee M, Hayashi H, Sakamoto N, Okuyama S. A case report of benign recurrent intrahepatic cholestasis. GASTROENTEROLOGIA JAPONICA 1984; 19:472-8. [PMID: 6519416 DOI: 10.1007/bf02807260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
A case of benign recurrent intrahepatic cholestasis was reported. A man had first experienced jaundice at the age of twenty-five, and suffered three subsequent attacks over the next five years. These attacks were characterized by prodromal severe pruritus. During the icteric phase, serum levels of total bile acids increased, most being conjugates of primary bile acids. Electron microscopy revealed that the bile canaliculi were filled with an increased volume of granular substances. Some bile canaliculi fused together resulting in the formation of abnormally elongated channels which abutted on the Disse space. These observations suggest bile regurgitation through the channel of altered canaliculi. In convalescence, these bile canaliculi disappeared. Every attack was followed by complete recovery of liver structure and function.
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Conroy B, Pennington CR. Transient ground glass hepatocellular change following a period of glue sniffing in a patient with underlying benign recurrent cholestatic jaundice. MEDICINE, SCIENCE, AND THE LAW 1984; 24:102-106. [PMID: 6727606 DOI: 10.1177/002580248402400207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
This report describes the liver biopsy findings in an obese adolescent male suffering from benign recurrent intrahepatic cholestatic jaundice who developed transient focal feathery swelling and ground glass hepatocellular change within several weeks of indulging in glue sniffing. Clinically the situation provided a rare opportunity to observe the nature and progress of morphological features by means of sequential liver biopsies taken for the investigation of the patient's underlying jaundice. The temporal relationship between the confessed period of glue sniffing and appearance of the hepatocellular abnormality provides, in our opinion, strong supportive evidence of a definite link between the two.
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23
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Bremmelgaard A, Sjövall J. Hydroxylation of cholic, chenodeoxycholic, and deoxycholic acids in patients with intrahepatic cholestasis. J Lipid Res 1980. [DOI: 10.1016/s0022-2275(20)34768-4] [Citation(s) in RCA: 71] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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van Berge-Henegouwen GP, Ferguson DR, Hofmann AF, De Pagter AG. Familial and nonfamilial benign recurrent cholestiasis distinguished by plasma disappearance of indocyanine green but not cholylglycine. Gut 1978; 19:345-9. [PMID: 658762 PMCID: PMC1412099 DOI: 10.1136/gut.19.5.345] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
To determine whether a defect in uptake of organic anions is present in patients with benign recurrent cholestasis, the plasma disappearance of simultaneously injected indocyanine green and cholyglycine-1-14C was measured in eight patients with asymptomatic benign recurrent cholestasis, four with the familial type, as well as 22 healthy control subjects. Evans blue was also simultaneously injected to permit correction for variation in blood volume and speed of mixing. Uptake of indocyanine green was decreased in all three patients with nonfamilial benign recurrent cholestatsis, but normal or increased in the four patients uith the familial form of the disorder. By contrast, cholyglycine-1-14C uptake was abnormal in one patient with each type of the disorder. Thus, patients with nonfamilial benign recurrent cholestasis have a defect in indocyanine green uptake, and patients with benign recurrent cholestasis are heterogeneous with respect to organic anion uptake.
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Abstract
An integrative survey is given of three disease processes, in which recent progress of a fundamental nature has been made, primarily affecting the liver, either coincident with or caused by the gravid state. The three conditions considered include (1) recurrent cholestasis of pregnancy (RCP), (2) viral hepatitis coincident with pregnancy, and (3) acute fatty liver of pregnancy (AFLP). In addition to an assessment of our present knowledge with respect to RCP and AFLP, new genetic hypotheses are proposed. In the latter, the proposal of an ornithine transcarbamylase deficiency, similar to that seen in Reye's syndrome, has potential therapeutic implications that are explored. In light of the currently available information on the interaction between maternal viral hepatitis and the variant forms of vertical maternal-fetal transmission, tentative recommendations regarding management of the newborn are suggested.
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Brunner G, Vido I, Perings E, Grünewälder H. [Studies on the effects of azathioprine, choline orotate and phenobarbital on enzymes of the endoplasmatic reticulum and mitochondria of rat liver]. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 1972; 274:325-36. [PMID: 4404242 DOI: 10.1007/bf00501270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Sigstad H, Aagenaes O, Bjorn-Hansen RW, Rootwelt K. Primary lymphoedema combined with hereditary recurrent intrahepatic cholestasis. ACTA MEDICA SCANDINAVICA 1970; 188:213-9. [PMID: 5526945 DOI: 10.1111/j.0954-6820.1970.tb08028.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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