1
|
Garrido I, Lopes S, Fonseca E, Carneiro F, Macedo G. Autoimmune hepatitis and eosinophilia: A rare case report. World J Hepatol 2023; 15:311-317. [PMID: 36926232 PMCID: PMC10011904 DOI: 10.4254/wjh.v15.i2.311] [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: 11/01/2022] [Revised: 12/13/2022] [Accepted: 01/05/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Autoimmune hepatitis consists of a chronic liver disease whose etiology is unknown. It is comprised of relevant immunological aspects and of immune-mediated liver injury. Eosinophilia may be a considerable feature, particularly happening in male patients.
CASE SUMMARY We report here a Crohn´s disease patient presenting with de novo hypergammaglobulinemia, circulating autoantibodies and elevated transaminase levels. He also had significant peripheral eosinophilia and elevated immunoglobulin E levels at diagnosis. The pathology findings from liver biopsy were compatible with autoimmune hepatitis with eosinophilic infiltration.
CONCLUSION This is the first report of autoimmune hepatitis with exuberant eosinophilic infiltration in the liver and bone marrow, described in a patient with Crohn’s disease.
Collapse
Affiliation(s)
- Isabel Garrido
- Department of Gastroenterology and Hepatology, Centro Hospitalar Universitário de São João; World Gastroenterology Organization Porto Training Center; Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Susana Lopes
- Department of Gastroenterology and Hepatology, Centro Hospitalar Universitário de São João; World Gastroenterology Organization Porto Training Center; Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Elsa Fonseca
- Department of Pathology, Centro Hospitalar Universitário de São João; Instituto de Investigação e Inovação em Saúde (i3S) and Institute of Molecular Pathology and Immunology, University of Porto (Ipatimup); Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Fátima Carneiro
- Department of Pathology, Centro Hospitalar Universitário de São João; Instituto de Investigação e Inovação em Saúde (i3S) and Institute of Molecular Pathology and Immunology, University of Porto (Ipatimup); Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Guilherme Macedo
- Department of Gastroenterology and Hepatology, Centro Hospitalar Universitário de São João; World Gastroenterology Organization Porto Training Center; Faculty of Medicine of the University of Porto, Porto, Portugal
| |
Collapse
|
2
|
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.
Collapse
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.
| |
Collapse
|
3
|
Mathä L, Romera-Hernández M, Steer CA, Yin YH, Orangi M, Shim H, Chang C, Rossi FM, Takei F. Migration of Lung Resident Group 2 Innate Lymphoid Cells Link Allergic Lung Inflammation and Liver Immunity. Front Immunol 2021; 12:679509. [PMID: 34305911 PMCID: PMC8299566 DOI: 10.3389/fimmu.2021.679509] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/24/2021] [Indexed: 11/29/2022] Open
Abstract
Group 2 innate lymphoid cells (ILC2s) are tissue resident in the lung and activated by inhaled allergens via epithelial-derived alarmins including IL-33. Activated ILC2s proliferate, produce IL-5 and IL-13, and induce eosinophilic inflammation. Here, we report that intranasal IL-33 or the protease allergen papain administration resulted in increased numbers of ILC2s not only in the lung but also in peripheral blood and liver. Analyses of IL-33 treated parabiosis mice showed that the increase in lung ILC2s was due to proliferation of lung resident ILC2s, whereas the increase in liver ILC2s was due to the migration of activated lung ILC2s. Lung-derived ILC2s induced eosinophilic hepatitis and expression of fibrosis-related genes. Intranasal IL-33 pre-treatment also attenuated concanavalin A-induced acute hepatitis and cirrhosis. These results suggest that activated lung resident ILC2s emigrate from the lung, circulate, settle in the liver and promote type 2 inflammation and attenuate type 1 inflammation.
Collapse
Affiliation(s)
- Laura Mathä
- Terry Fox Laboratory, British Columbia Cancer, Vancouver, BC, Canada.,Interdisciplinary Oncology Program, University of British Columbia, Vancouver, BC, Canada
| | - Mónica Romera-Hernández
- Terry Fox Laboratory, British Columbia Cancer, Vancouver, BC, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Catherine A Steer
- Terry Fox Laboratory, British Columbia Cancer, Vancouver, BC, Canada
| | - Yi Han Yin
- Terry Fox Laboratory, British Columbia Cancer, Vancouver, BC, Canada
| | - Mona Orangi
- Terry Fox Laboratory, British Columbia Cancer, Vancouver, BC, Canada.,Interdisciplinary Oncology Program, University of British Columbia, Vancouver, BC, Canada
| | - Hanjoo Shim
- Terry Fox Laboratory, British Columbia Cancer, Vancouver, BC, Canada
| | - ChihKai Chang
- Biomedical Research Centre, University of British Columbia, Vancouver, BC, Canada
| | - Fabio M Rossi
- Biomedical Research Centre, University of British Columbia, Vancouver, BC, Canada.,Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Fumio Takei
- Terry Fox Laboratory, British Columbia Cancer, Vancouver, BC, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
4
|
Zuberi FF, Zuberi BF, Rasheed T, Nawaz Z. Non-specific impairment of Lung Function on Spirometery in Patients with Chronic Hepatitis-C. Pak J Med Sci 2019; 35:360-364. [PMID: 31086515 PMCID: PMC6500828 DOI: 10.12669/pjms.35.2.73] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Objectives: To document frequency of non-specific impairment of lung functions (NILF) in patients of HCV and to compare according to gender, genotype, liver fibrosis score and smoking status. Methods: Patients of chronic hepatitis C were included after informed consent. Demographic data was recorded, and they underwent baseline investigations, fibroscan, abdominal ultrasound and PFT. Patients were segregated on basis of gender, fibroscan stages and smoking status. NILF was labelled if any two of three criteria are fulfilled (a) FVC < 80% of Predicted, (b) FEV1 < 80% Predicted, (c) FEV1/FVC ≥ 70. Results: Two hundred thirty four patients were of chronic HCV who fulfilled the selection criteria were inducted in study. These included 49.6% males and 50.4% females. There were 15.0% smokers, 16.2% were ex-smokers while 68.8% were never smokers. NILF was present in 130 (55.6%) out of which 61.5% were female and 38.5% were male (p <0.001), its presence in smokers was 56.2% and in never smokers was 55.3% (p=0.507). Presence of NILF increased with Fibroscan stages from F1 to F4 (p <0.001). Conclusions: NILF pattern on spirometry with normal chest radiograph is common among HCV patients. It was found more common in females and frequency increased progressively with fibro scan stages.
Collapse
Affiliation(s)
- Faisal Faiyaz Zuberi
- Faisal Faiyaz Zuberi, FCPS (Med), FCPS (Pulmo). Ojha Institute of Chest Diseases Dow University of Health Sciences, Karachi, Pakistan
| | - Bader Faiyaz Zuberi
- Bader Faiyaz Zuberi, FCPS. Dow Medical College Dow University of Health Sciences, Karachi, Pakistan
| | - Tazeen Rasheed
- Tazeen Rasheed, FCPS. Dow Medical College Dow University of Health Sciences, Karachi, Pakistan
| | - Zunaira Nawaz
- Zunaira Nawaz, FCPS. Dow Medical College Dow University of Health Sciences, Karachi, Pakistan
| |
Collapse
|
5
|
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.
Collapse
Affiliation(s)
- Tomoe Kawamura
- Gastroenterology Center, Ehime Prefectural Central Hospital, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|