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Ogata T, Sakai T, Shibata S, Kanno H, Nakane H, Aoyagi T, Koikawa K, Sadakari Y, Hirokata G, Taniguchi M. Spontaneous clearance of serum HCV-RNA after splenectomy in a patient with HCV-related liver cirrhosis and portal hypertension: a case report. Surg Case Rep 2024; 10:94. [PMID: 38647617 PMCID: PMC11035502 DOI: 10.1186/s40792-024-01899-6] [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: 03/02/2024] [Accepted: 04/13/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Spontaneous clearance of chronic hepatitis C virus (HCV) is rare in adults. A T-lymphocyte response is thought to be involved in HCV-RNA clearance. Splenectomy reportedly has a beneficial effect on T cell immune function in patients with cirrhosis. To the best of our knowledge, the present report is the first to describe spontaneous clearance of serum HCV-RNA within 1 year after splenectomy in a patient with cirrhosis. CASE PRESENTATION A 55-year-old man with HCV cirrhosis was transferred to our institution with advanced pancytopenia, splenomegaly, and gastric varices. He had a 1-year history of ascites, edema, and general fatigue. The patient had a Child-Pugh score of 8 and serological type 1 HCV; the HCV-RNA level was 4.7 log IU/mL. Contrast-enhanced computed tomography showed gastric varices and marked splenomegaly (estimated spleen volume of 2175 mL). Esophagogastroduodenoscopy revealed enlarged gastric varices with no red color sign, and the varices were larger than those 1 year prior. He was diagnosed with decompensated HCV-related liver cirrhosis and portal hypertension. We considered direct-acting antiviral (DAA) therapy; however, DAA therapy was not approved in Japan for patients with decompensated cirrhosis at that time. Hand-assisted laparoscopic splenectomy was performed to improve the worsening portal hypertension. Further, we planned the initiation of DAA therapy after surgery, when such therapy would become available. DAA therapy was approved 1 year after splenectomy. At that time, we measured the HCV-RNA level before the initiation of DAA therapy; unexpectedly, however, serum HCV-RNA was not detectable, and the virus continued to disappear during the following 4 years. His liver function (total bilirubin, albumin, and prothrombin time) and pancytopenia improved during the 5 years postoperatively. The serum aspartate and alanine aminotransferase levels normalized between 1 and 5 years postoperatively. Esophagogastroduodenoscopy showed no change in the gastric varices during the 5 years after surgery. The patient remained asymptomatic and continued to do well. CONCLUSIONS We have presented a case of spontaneous clearance of HCV-RNA after splenectomy in a patient with cirrhosis and portal hypertension. Splenectomy may be associated with disappearance of HCV-RNA based on previous reports. More cases should be accumulated and evaluated.
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Affiliation(s)
- Toshiro Ogata
- Department of Surgery, St. Mary's Hospital, 422 Tsubukuhonmachi, Kurume, Fukuoka, 830-8543, Japan.
| | - Terufumi Sakai
- Department of Gastroenterology, St. Mary's Hospital, 422 Tsubukuhonmachi, Fukuoka, Kurume, 830-8543, Japan
| | - Sho Shibata
- Department of Gastroenterology, St. Mary's Hospital, 422 Tsubukuhonmachi, Fukuoka, Kurume, 830-8543, Japan
| | - Hiroki Kanno
- Department of Surgery, St. Mary's Hospital, 422 Tsubukuhonmachi, Kurume, Fukuoka, 830-8543, Japan
| | - Hiroyuki Nakane
- Department of Surgery, St. Mary's Hospital, 422 Tsubukuhonmachi, Kurume, Fukuoka, 830-8543, Japan
| | - Takeshi Aoyagi
- Department of Surgery, St. Mary's Hospital, 422 Tsubukuhonmachi, Kurume, Fukuoka, 830-8543, Japan
| | - Kazuhiro Koikawa
- Department of Surgery, St. Mary's Hospital, 422 Tsubukuhonmachi, Kurume, Fukuoka, 830-8543, Japan
| | - Yoshihiko Sadakari
- Department of Surgery, St. Mary's Hospital, 422 Tsubukuhonmachi, Kurume, Fukuoka, 830-8543, Japan
| | - Gentaro Hirokata
- Department of Surgery, St. Mary's Hospital, 422 Tsubukuhonmachi, Kurume, Fukuoka, 830-8543, Japan
| | - Masahiko Taniguchi
- Department of Surgery, St. Mary's Hospital, 422 Tsubukuhonmachi, Kurume, Fukuoka, 830-8543, Japan
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Pott H, Bricks G, Senise JF, Castelo A. Chronic alcohol abuse and spontaneous clearance of hepatitis C virus. IDCases 2019; 17:e00534. [PMID: 31384553 PMCID: PMC6667488 DOI: 10.1016/j.idcr.2019.e00534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 04/05/2019] [Accepted: 04/05/2019] [Indexed: 02/07/2023] Open
Abstract
Spontaneous clearance of hepatitis C virus (HCV) is an uncommon occurrence in the course of chronic infection. We reported a rare case of a 41-year-old male patient infected with HCV genotype 3a who presented spontaneous viral elimination after increasing his daily consumption of alcoholic beverage. In this short review, we overview how modulation of the hepatic inflammatory response could have a role in the viral elimination process.
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Affiliation(s)
- Henrique Pott
- Departament of Medicine, Universidade Federal de São Carlos (UFSCar), São Carlos, Brazil
- Division of Infectious Diseases, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
- Corresponding author at: Departament of Medicine, Universidade Federal de São Carlos, Rodovia Washington Luis, km 235, São Carlos, SP, 13565-905, Brazil.
| | - Guilherme Bricks
- Division of Infectious Diseases, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Jorge Figueiredo Senise
- Division of Infectious Diseases, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Adauto Castelo
- Division of Infectious Diseases, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
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