1
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Bitar R, Kaur M, Crandall I, McNamara R, Revzin MV. Ultrasound evaluation of portal venous gas and its mimics. Abdom Radiol (NY) 2024; 49:2756-2769. [PMID: 38735019 DOI: 10.1007/s00261-024-04328-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/31/2024] [Accepted: 04/02/2024] [Indexed: 05/13/2024]
Abstract
Portal venous gas on abdominal ultrasound classically represents an indirect indicator of bowel ischemia, a critical condition which poses a high patient mortality and therefore warrants emergent corrective action. While the classic appearance of portal venous gas on ultrasound is well-described in the literature, the characteristic descriptors are nonspecific and may actually represent other less emergent mimics. Therefore, while radiologists should remain vigilant for the detection of findings corresponding to portal venous gas, they should also be aware of similar-appearing entities in order to provide the most accurate diagnosis. This pictorial essay will open with imaging examples of true portal venous gas attributable to bowel ischemia and describe the classic features which should alert radiologists to this specific diagnosis. Subsequently, this pictorial essay will provide imaging examples of other various other clinical entities which on ultrasound may share similar imaging characteristics. An important objective of this pictorial essay is to highlight distinguishing imaging features along with specific clinical circumstances for each pathological entity which can direct radiologists into identifying the correct diagnosis.
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Affiliation(s)
- Ryan Bitar
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Manroop Kaur
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Ian Crandall
- Department of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Robert McNamara
- Department of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Margarita V Revzin
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA.
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2
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Kaufman R, Sanchez JM, Amer R. The Great Imitator Masquerading as Autoimmune Hepatitis and Demystifying as Fulminant Syphilitic Retinitis. Ocul Immunol Inflamm 2024:1-5. [PMID: 38669600 DOI: 10.1080/09273948.2024.2345290] [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: 02/23/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024]
Abstract
PURPOSE Syphilis is a "Great Masquerader" because of its versatile clinical manifestations. We aim to report a patient whose first presentation was with presumed autoimmune hepatitis. Fulminant retinitis subsequently ensued, thus enabling correct diagnosis and treatment. METHODS Case description. RESULTS A 62-year-old male presented with bilateral drop in vision. One month earlier, right eye (RE) arteritic ischemic optic neuropathy was suspected because of severe headache, sudden drop in vision, relative afferent pupillary defect, and elevated inflammatory markers. Systemic steroids were instituted. Brain imaging and temporal artery biopsy were unyielding. Four months earlier, liver biopsy performed because of elevated cholestatic liver enzymes, revealed granulomatous hepatitis. After ruling out viral hepatitis, autoimmune etiology was presumed, and prednisone was started. On presentation, visual acuity (VA) was counting fingers in RE and 6/20 in the left eye (LE). Bilateral panuveitis with punctate inner retinitis, placoid chorioretinitis was diagnosed. Serological tests were strongly positive for syphilis. Lumbar puncture confirmed the existence of neurosyphilis. Systemic penicillin was initiated. One month later, VA improved to RE 6/10, LE 6/7.5, with marked resolution of posterior uveitis. No recurrence was observed over 27-month-period. CONCLUSION Acquired syphilitic hepatitis is rarely reported. Administering steroids potentially aggravated the infection. The characteristic features of placoid chorioretinitis and punctate inner retinitis connected the pieces of the puzzle together to the diagnosis of ocular and neurosyphilis. Intrahepatic cholestasis with negative serological panel of hepatotropic pathogens should raise the suspicion of non-hepatotropic pathogens especially syphilis.
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Affiliation(s)
- Ron Kaufman
- Department of Ophthalmology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Juan Martin Sanchez
- Department of Ophthalmology, Hadassah Medical Organization, Jerusalem, Israel
| | - Radgonde Amer
- Department of Ophthalmology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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3
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Iordache A, Fuursted K, Rift CV, Rasmussen A, Willemoe GL, Hasselby JP. Hepatic granulomas following liver transplantation: A retrospective survey, and analysis of possible microbiological etiology. Pathol Res Pract 2024; 255:155201. [PMID: 38367601 DOI: 10.1016/j.prp.2024.155201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Liver granulomas have always been a diagnostic challenge for pathologists. They have been described in up to 15% of liver biopsies and can also be seen in liver allograft biopsy specimens, but there is a paucity of information regarding the prevalence and associated etiologic factors of granulomas in liver transplanted patients. The aim of this study is to shed light on the etiology of liver granulomas. METHODS Liver biopsies from liver transplanted patients, in the period from 01.01.2011 - 01.05.2017, were examined. We registered the histo-morphological characteristics and clinicopathological data of all biopsies and performed next-generation sequencing (NGS) to detect possible pathogens (bacteria, fungi, and parasites) in the biopsies containing granulomas. RESULTS We reviewed a total of 400 liver biopsies from 217 liver transplant patients. Of these, 131 liver biopsies (32.8%) from 98 patients (45.2%) revealed granulomas. Most were epithelioid granulomas located parenchymal and were detected in 115 (87.7%) biopsies. We also identified 10 cases (7.6%) with both lobular and portal granulomas and six biopsies (4.5%) with portal granulomas alone. In 54 biopsies (41.2%), granulomas were found in biopsies with acute cellular rejection (ACR). Fifty (51%) patients with granulomas underwent liver transplantation for autoimmune-related end-stage liver disease (AILD). The granulomas were found most frequently in the first six months after transplantation, where patients also more often were biopsied. NGS analysis did not reveal any potential infectious agent, and no significant differences were observed in the microbiological diversity (microbiome) between clinical- and granuloma characteristics concerning bacteria, fungi, and parasites. CONCLUSION Our study confirmed that granulomas are frequently seen in liver allograft biopsy specimens, and most often localized in the parenchyma, occurring in the first post-transplant period in patients with AILD, and often seen simultaneously with episodes of ACR. Neither a specific microbiological etiological agent nor a consistent microbiome was detected in any case.
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Affiliation(s)
- Anisoara Iordache
- Department of Pathology, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark
| | - Kurt Fuursted
- Department of Microbiology and Infection Control, Reference Laboratory, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark
| | | | - Allan Rasmussen
- Department of Surgical Gastroenterology, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark
| | - Gro Linno Willemoe
- Department of Pathology, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark
| | - Jane Preuss Hasselby
- Department of Pathology, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark
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4
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Harvest CK, Abele TJ, Yu C, Beatty CJ, Amason ME, Billman ZP, DePrizio MA, Souza FW, Lacey CA, Maltez VI, Larson HN, McGlaughon BD, Saban DR, Montgomery SA, Miao EA. An innate granuloma eradicates an environmental pathogen using Gsdmd and Nos2. Nat Commun 2023; 14:6686. [PMID: 37865673 PMCID: PMC10590453 DOI: 10.1038/s41467-023-42218-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 09/21/2023] [Indexed: 10/23/2023] Open
Abstract
Granulomas often form around pathogens that cause chronic infections. Here, we discover an innate granuloma model in mice with an environmental bacterium called Chromobacterium violaceum. Granuloma formation not only successfully walls off, but also clears, the infection. The infected lesion can arise from a single bacterium that replicates despite the presence of a neutrophil swarm. Bacterial replication ceases when macrophages organize around the infection and form a granuloma. This granuloma response is accomplished independently of adaptive immunity that is typically required to organize granulomas. The C. violaceum-induced granuloma requires at least two separate defense pathways, gasdermin D and iNOS, to maintain the integrity of the granuloma architecture. This innate granuloma successfully eradicates C. violaceum infection. Therefore, this C. violaceum-induced granuloma model demonstrates that innate immune cells successfully organize a granuloma and thereby resolve infection by an environmental pathogen.
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Affiliation(s)
- Carissa K Harvest
- Department of Integrative Immunobiology, Duke University School of Medicine, Durham, NC, USA
- Department of Molecular Genetics and Microbiology, Duke University School of Medicine, Durham, NC, USA
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Taylor J Abele
- Department of Integrative Immunobiology, Duke University School of Medicine, Durham, NC, USA
- Department of Molecular Genetics and Microbiology, Duke University School of Medicine, Durham, NC, USA
| | - Chen Yu
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
| | - Cole J Beatty
- Department of Integrative Immunobiology, Duke University School of Medicine, Durham, NC, USA
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
| | - Megan E Amason
- Department of Integrative Immunobiology, Duke University School of Medicine, Durham, NC, USA
- Department of Molecular Genetics and Microbiology, Duke University School of Medicine, Durham, NC, USA
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Zachary P Billman
- Department of Integrative Immunobiology, Duke University School of Medicine, Durham, NC, USA
- Department of Molecular Genetics and Microbiology, Duke University School of Medicine, Durham, NC, USA
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Morgan A DePrizio
- Department of Integrative Immunobiology, Duke University School of Medicine, Durham, NC, USA
- Department of Molecular Genetics and Microbiology, Duke University School of Medicine, Durham, NC, USA
| | - Fernando W Souza
- Department of Integrative Immunobiology, Duke University School of Medicine, Durham, NC, USA
- Department of Molecular Genetics and Microbiology, Duke University School of Medicine, Durham, NC, USA
- Department of Cell Biology, Duke University School of Medicine, Durham, NC, USA
| | - Carolyn A Lacey
- Department of Integrative Immunobiology, Duke University School of Medicine, Durham, NC, USA
- Department of Molecular Genetics and Microbiology, Duke University School of Medicine, Durham, NC, USA
| | - Vivien I Maltez
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Heather N Larson
- Department of Integrative Immunobiology, Duke University School of Medicine, Durham, NC, USA
- Department of Molecular Genetics and Microbiology, Duke University School of Medicine, Durham, NC, USA
| | - Benjamin D McGlaughon
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Daniel R Saban
- Department of Integrative Immunobiology, Duke University School of Medicine, Durham, NC, USA
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
| | - Stephanie A Montgomery
- Department of Pathology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Edward A Miao
- Department of Integrative Immunobiology, Duke University School of Medicine, Durham, NC, USA.
- Department of Molecular Genetics and Microbiology, Duke University School of Medicine, Durham, NC, USA.
- Department of Cell Biology, Duke University School of Medicine, Durham, NC, USA.
- Department of Pathology, Duke University School of Medicine, Durham, NC, USA.
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5
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Omachi K, Imai K, Nakao Y, Nakamura H, Kaida T, Shiraishi Y, Itoyama R, Nitta H, Hayashi H, Asato T, Mikami Y, Baba H. A surgical resection of hepatic granuloma mimicking intrahepatic cholangiocarcinoma: a case report. Int Cancer Conf J 2023; 12:195-199. [PMID: 37251010 PMCID: PMC10212907 DOI: 10.1007/s13691-023-00607-9] [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: 11/26/2022] [Accepted: 03/28/2023] [Indexed: 05/31/2023] Open
Abstract
Hepatic granuloma is relatively rare, and benign tumor of the liver. Herein, we report an unusual case of hepatic granuloma mimicking intrahepatic cholangiocarcinoma (ICC). An 82-year-old woman with a history of viral hepatitis B was admitted for investigation of liver mass in the left lobe. Dynamic computed tomography revealed a mostly hypo-enhancing main tumor with a peripheral ring enhancement, and positron emission tomography demonstrated localized an abnormal accumulation of fludeoxyglucose. Considering the possibility of malignant disease, extended left hepatectomy was performed. The resected tumor was macroscopically a periductal infiltrating nodular type, 4.5 × 3.6 cm in diameter. The pathological findings showed that granuloma and coagulative necrosis were present, and diagnosis of hepatic granuloma was confirmed. Pathological studies demonstrated that periodic acid-Schiff stain, Grocott-Gomori stain and Ziehl-Neelsen stain were all negative in the lesion.
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Affiliation(s)
- Kazuki Omachi
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-Ku, Kumamoto, 860-8556 Japan
| | - Katsunori Imai
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-Ku, Kumamoto, 860-8556 Japan
| | - Yosuke Nakao
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-Ku, Kumamoto, 860-8556 Japan
| | - Hiro Nakamura
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-Ku, Kumamoto, 860-8556 Japan
| | - Takayoshi Kaida
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-Ku, Kumamoto, 860-8556 Japan
| | - Yuta Shiraishi
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-Ku, Kumamoto, 860-8556 Japan
| | - Rumi Itoyama
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-Ku, Kumamoto, 860-8556 Japan
| | - Hidetoshi Nitta
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-Ku, Kumamoto, 860-8556 Japan
| | - Hiromitsu Hayashi
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-Ku, Kumamoto, 860-8556 Japan
| | - Tsuguharu Asato
- Department of Diagnostic Pathology, Kumamoto University Hospital, Kumamoto, Japan
| | - Yoshiki Mikami
- Department of Diagnostic Pathology, Kumamoto University Hospital, Kumamoto, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-Ku, Kumamoto, 860-8556 Japan
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6
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Nygaard UC, Vege Å, Rognum T, Grob K, Cartier C, Cravedi JP, Alexander J. Toxic effects of mineral oil saturated hydrocarbons (MOSH) and relation to accumulation in rat liver. Food Chem Toxicol 2023; 177:113847. [PMID: 37262937 DOI: 10.1016/j.fct.2023.113847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Humans are daily exposed to mineral oil saturated hydrocarbons (MOSH) from the diet. We exposed female Fischer 344 rats to a broad mixture and sub-fractions of MOSH. Chemical characterization of the MOSH mixture used and material accumulated in rat tissues were previously reported (Barp et al. 2017a, 2017b). Rats were exposed to feed containing 0-4000 mg/kg broad MOSH mixture for 30, 60, 90 and 120 days; and for 120 days to feed containing different MOSH fractions: i) mainly molecular masses < C25 (S-C25), ii) dewaxed, mainly molecular masses > C25 (L-C25) and iii) the L-C25 fraction mixed with wax largely consisting of n-alkanes > C25 (L-C25W). Treatments related effects were increased liver and spleen weight, as well as vacuolization and granuloma formation with lymphoid cell clusters in the liver, but effects varied strongly between the MOSH fractions tested. We conclude that increased liver and spleen weights were related to accumulated n-alkanes (wax) above C25, presumably not relevant for humans, but also to MOSH from S-C25, mainly consisting of iso-alkanes and substituted cycloalkanes below C25 with a small proportion of n-alkanes. Induction of liver granuloma appeared to be related to n-alkanes > C25 and not to the accumulated amount of MOSH. Immune responses to an injected antigen were not affected. Iso-alkanes and substituted cycloalkanes accumulating in rat liver and spleen were similar to those accumulating in humans.
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Affiliation(s)
- Unni Cecilie Nygaard
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, P.O.Box 4404 Nydalen, N-0403, Oslo, Norway.
| | - Åshild Vege
- Department of Forensic Medicine, University of Oslo, Norway; Department for Forensic Sciences, Oslo University Hospital, Norway.
| | - Torleiv Rognum
- Department of Forensic Medicine, University of Oslo, Norway; Department for Forensic Sciences, Oslo University Hospital, Norway.
| | - Koni Grob
- Official Food Control Authority of the Canton of Zurich, Fehrenstrasse 15, CH-8032, Zurich, Switzerland.
| | - Christel Cartier
- Toxalim (Research Centre in Food Toxicology), INRA, ENVT, INP-Purpan, UPS, Toulouse, France.
| | - Jean-Pierre Cravedi
- Toxalim (Research Centre in Food Toxicology), INRA, ENVT, INP-Purpan, UPS, Toulouse, France.
| | - Jan Alexander
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, P.O.Box 4404 Nydalen, N-0403, Oslo, Norway.
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7
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Harvest CK, Abele TJ, Yu C, Beatty CJ, Amason ME, Billman ZP, DePrizio MA, Lacey CA, Maltez VI, Larson HN, McGlaughon BD, Saban DR, Montgomery SA, Miao EA. An innate granuloma eradicates an environmental pathogen using Gsdmd and Nos2. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.03.07.531568. [PMID: 36945446 PMCID: PMC10028874 DOI: 10.1101/2023.03.07.531568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
Granulomas often form around pathogens that cause chronic infections. Here, we discover a novel granuloma model in mice. Chromobacterium violaceum is an environmental bacterium that stimulates granuloma formation that not only successfully walls off but also clears the infection. The infected lesion can arise from a single bacterium that replicates in the presence of a neutrophil swarm. Bacterial replication ceases when macrophages organize around the infection and form a granuloma. This granuloma response is accomplished independently of adaptive immunity that is typically required to organize granulomas. The C. violaceum -induced granuloma requires at least two separate defense pathways, gasdermin D and iNOS, to maintain the integrity of the granuloma architecture. These innate granulomas successfully eradicate C. violaceum infection. Therefore, this new C. violaceum -induced granuloma model demonstrates that innate immune cells successfully organize a granuloma and thereby eradicate infection by an environmental pathogen.
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8
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Subedi A, Hoilat G, Kumar VCS, Bhutta A, Subedi AS, Gupta A. Syphilitic hepatitis as a manifestation of secondary syphilis. Proc AMIA Symp 2021; 34:696-697. [PMID: 34732991 DOI: 10.1080/08998280.2021.1936362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Syphilis is a multisystem disease caused by the spirochete Treponema pallidum. Among various organs affected, liver involvement is seen infrequently and can be missed. Here we present a case of hepatitis due to secondary syphilis that completely resolved with penicillin G therapy.
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Affiliation(s)
- Abinash Subedi
- Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, New York
| | - Gilles Hoilat
- Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, New York
| | | | - Abdul Bhutta
- Division of Gastroenterology, SUNY Upstate Medical University, Syracuse, New York.,Division of Gastroenterology, VA Medical Center, Syracuse, New York
| | | | - Anand Gupta
- Division of Gastroenterology, VA Medical Center, Syracuse, New York
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9
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Miyasaka A, Sato S, Masuda T, Takikawa Y. A 55-Year-Old Japanese Man with Multiple Sclerosis Diagnosed with Disseminated Tuberculosis Identified by Liver Function Abnormalities: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e931369. [PMID: 34404756 PMCID: PMC8382023 DOI: 10.12659/ajcr.931369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Patient: Male, 55-year-old
Final Diagnosis: Tuberculosis
Symptoms: Liver
Medication: —
Clinical Procedure: —
Specialty: Infectious Diseases
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Affiliation(s)
- Akio Miyasaka
- Division of Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Shiwa, Iwate, Japan
| | - Shinichirou Sato
- Department of Gastroenterology, Sato Clinic, Hanamaki, Iwate, Japan
| | - Tomoyuki Masuda
- Department of Pathology, Iwate Medical University School of Medicine, Shiwa, Iwate, Japan
| | - Yasuhiro Takikawa
- Division of Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Shiwa, Iwate, Japan
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10
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Gusmão MAN, Júnior SM, Marconato DG, Emídio NB, Farani PSG, Gollner ÂM, Araújo N, Coelho PMZ, Macedo GC, da Silva Filho AA, Vasconcelos EG, de Faria-Pinto P. Potato apyrase reduces granulomatous area and increases presence of multinucleated giant cells in murine schistosomiasis. Parasitol Int 2021; 83:102317. [PMID: 33676013 DOI: 10.1016/j.parint.2021.102317] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 02/23/2021] [Accepted: 02/25/2021] [Indexed: 11/28/2022]
Abstract
Granulomas are inflammatory tissue responses directed to a set of antigens. Trapped Schistosoma mansoni eggs promote productive granulomas in the tissues, and they are the main damage caused by schistosomiasis. Some S. mansoni antigenic proteins may have a direct involvement in the resolution of the granulomatous response. The ATP diphosphohydrolases isoforms of this parasite are immunogenic, expressed in all phases of the parasite life cycle and secreted by eggs and adult worms. Potato apyrase is a vegetable protein that cross-reactive with parasite ATP diphosphohydrolases isoforms. In this study, the vegetable protein was purified, before being inoculated in C57BL/6 mice that were later infected with cercariae. Sixty days after infection, adult worms were recovered, antibodies and cytokines were measured, and morphological granuloma alterations evaluated. Immunization of the animals induced significant levels of IgG and IgG1 antibodies and IFN-γ, IL-10 and IL-5 cytokines, but not IL-13, suggesting that potato apyrase is an immunoregulatory protein. Supporting this hypothesis, it was found that liver damage associated with schistosomiasis was mitigated, reducing the size of the areas affected by granuloma to 35% and increasing the presence of multinucleated giant cells in this environment. In conclusion, potato apyrase was found to be effective immunomodulatory antigen for murine schistosomiasis.
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Affiliation(s)
- Michélia A N Gusmão
- Department of Biochemistry, Department of Parasitology, Microbiology and Immunology, Institute of Biological Sciences, Federal University of Juiz de Fora, Campus, Juiz de Fora, MG, Brazil
| | - Sérgio Mendanha Júnior
- Department of Biochemistry, Department of Parasitology, Microbiology and Immunology, Institute of Biological Sciences, Federal University of Juiz de Fora, Campus, Juiz de Fora, MG, Brazil
| | - Danielle G Marconato
- Department of Biochemistry, Department of Parasitology, Microbiology and Immunology, Institute of Biological Sciences, Federal University of Juiz de Fora, Campus, Juiz de Fora, MG, Brazil
| | - Nayara B Emídio
- Department of Biochemistry, Department of Parasitology, Microbiology and Immunology, Institute of Biological Sciences, Federal University of Juiz de Fora, Campus, Juiz de Fora, MG, Brazil
| | - Priscila Silva Grijó Farani
- Department of Biochemistry, Department of Parasitology, Microbiology and Immunology, Institute of Biological Sciences, Federal University of Juiz de Fora, Campus, Juiz de Fora, MG, Brazil
| | - Ângela M Gollner
- University Hospital, Federal University of Juiz de Fora, Campus, Juiz de Fora, MG, Brazil
| | - Neusa Araújo
- René Rachou Research Center, Oswaldo Cruz Foundation, FIOCRUZ, Belo Horizonte, MG, Brazil
| | - Paulo M Z Coelho
- René Rachou Research Center, Oswaldo Cruz Foundation, FIOCRUZ, Belo Horizonte, MG, Brazil
| | - Gilson Costa Macedo
- Department of Biochemistry, Department of Parasitology, Microbiology and Immunology, Institute of Biological Sciences, Federal University of Juiz de Fora, Campus, Juiz de Fora, MG, Brazil
| | - Ademar Alves da Silva Filho
- Department of Pharmaceutical Science, Faculty of Pharmacy, Federal University of Juiz de Fora, Campus, Juiz de Fora, MG, Brazil
| | - Eveline G Vasconcelos
- Department of Biochemistry, Department of Parasitology, Microbiology and Immunology, Institute of Biological Sciences, Federal University of Juiz de Fora, Campus, Juiz de Fora, MG, Brazil
| | - Priscila de Faria-Pinto
- Department of Biochemistry, Department of Parasitology, Microbiology and Immunology, Institute of Biological Sciences, Federal University of Juiz de Fora, Campus, Juiz de Fora, MG, Brazil.
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11
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Abstract
Gastrointestinal (GI) tuberculosis (TB) remains a significant problem worldwide, and may involve the luminal GI tract from oral cavity to perianal area in addition to associated viscera and peritoneum. Although GI TB more commonly affects immunocompromised hosts, it can also occur in immunocompetent people. Diagnosis is difficult because it usually mimics a malignancy or inflammatory bowel disease. A high index of clinical suspicion and appropriate use of combined investigative methods help in early diagnosis, and reduce morbidity and mortality. Anti-TB therapy is the same as for pulmonary disease, and invasive and specialized interventions are reserved for selected complications.
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Affiliation(s)
- Haluk Eraksoy
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Faculty of Medicine, Istanbul University, TR-34093 Istanbul, Turkey.
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12
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Wee J, Sobhi S, De Boer B, Xu D. Liver rheumatoid nodules imitating liver malignancy: a rare occurrence. BMJ Case Rep 2020; 13:13/12/e234366. [PMID: 33328208 DOI: 10.1136/bcr-2020-234366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We describe a case of a 61-year-old man with a background of rheumatoid arthritis who presented to the emergency department with a single-reported episode of haemoptysis on the background of an upper respiratory tract infection. A CT scan revealed an incidental 40 mm mass in upper right lobe of the liver abutting the diaphragmatic surface. A subsequent positron emission tomography scan confirmed the mass and raised the possibility of another lesion in the liver raising the suspicion of malignancy. The case was complicated by the inability to perform a fine needle aspiration biopsy due to the mass' proximity to the diaphragm. After discussion with the patient, it was decided to resect the affected liver segment. Histological analysis of the mass revealed localised necrotising granulomatous inflammation suggestive of a rheumatoid nodule, which is seldom reported in the literature.
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Affiliation(s)
- Jason Wee
- Faculty of Health and Medical Sciences, University of Western Australia, Crawley, Western Australia, Australia
| | - Salar Sobhi
- Faculty of Health and Medical Sciences, University of Western Australia, Crawley, Western Australia, Australia
| | - Bastiaan De Boer
- Faculty of Health and Medical Sciences, University of Western Australia, Crawley, Western Australia, Australia.,Anatomical Pathology, PathWest Laboratory Medical WA, Murdoch, Western Australia, Australia
| | - Dan Xu
- School of Public Health, Curtin University Bentley Campus, Perth, Western Australia, Australia .,Medical Education, Sun Yan-sen University of Medical Sciences, Guangzhou, China
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13
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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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14
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Bekki T, Yamamoto Y, Saeki Y, Arihiro K, Tanabe K, Ohdan H. Iatrogenic hepatic granuloma (suspected liver metastatic lesion on imaging) caused by liver retraction during laparoscopic gastrectomy: A case report. Clin Case Rep 2020; 8:2353-2357. [PMID: 33363739 PMCID: PMC7752566 DOI: 10.1002/ccr3.3100] [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: 04/27/2020] [Revised: 06/10/2020] [Accepted: 06/16/2020] [Indexed: 11/10/2022] Open
Abstract
There are no previous reports of hepatic granuloma secondary to intraoperative liver retraction. Using softer hepatic retraction instruments and keeping hepatic retraction time to a minimum are vital in preventing postoperative liver damage.
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Affiliation(s)
- Tomoaki Bekki
- Department of Gastroenterological and Transplant SurgeryApplied Life SciencesInstitute of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
| | - Yuji Yamamoto
- Department of Gastroenterological and Transplant SurgeryApplied Life SciencesInstitute of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
| | - Yoshihiro Saeki
- Department of Gastroenterological and Transplant SurgeryApplied Life SciencesInstitute of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
| | - Koji Arihiro
- Department of PathologyHiroshima UniversityHiroshimaJapan
| | - Kazuaki Tanabe
- Department of Gastroenterological and Transplant SurgeryApplied Life SciencesInstitute of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
| | - Hideki Ohdan
- Department of Gastroenterological and Transplant SurgeryApplied Life SciencesInstitute of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
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15
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[A severely ill 33-year-old woman with hepatic abscesses]. Internist (Berl) 2020; 61:518-521. [PMID: 32270231 DOI: 10.1007/s00108-020-00783-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
A 33-year-old woman in a seriously ill state presented with hepatic abscesses. The proof of epitheloid-like reactions by biopsy and further serological analysis led to the final diagnosis of tularemia, which represents a rare disease in Germany. Thereafter targeted antibiotic therapy was successfully initiated. The contribution of simultaneously diagnosed celiac disease to the unusual manifestation of tularemia in the liver, remains uncertain.
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16
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Kocabaş E, Özgür Gündeşlioğlu Ö, Kılıç Çil M, Çay Ü, Doran F, Soyupak S. A rare cause of granulomatous hepatitis: Tularemia. J Infect Public Health 2020; 13:1003-1005. [PMID: 31937491 DOI: 10.1016/j.jiph.2019.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 10/16/2019] [Accepted: 12/17/2019] [Indexed: 11/26/2022] Open
Abstract
Tularemia is a zoonotic infection caused by Francisella tularensis. Tularemia has several clinical form in humans, including ulceroglandular, pneumonic, oropharyngeal, oculoglandular, and systemic (typhoidal). Tularemia may develop granulomatous and suppurative lesions, especially in the affected regional lymph nodes and various organs. Patients with hepatic involvement typically have elevated transaminase levels, hepatomegaly and rarely jaundice. Histologically, there are typically suppurative microabscesses with occasional surrounding macrophages. Rarely, hepatic granuloma can develop due to tularemia. We present a case of an 8 year-old male residing in a rural village in Turkey, who came to our hospital after having intermittent fever for four months and right upper abdominal pain for two months. Liver had a nodular appearance in liver imaging and liver biopsy were consistent with granulomatous hepatitis. The microagglutination test was positive for tularemia in the patient who was investigated for granulomatous hepatitis etiology. Symptoms and signs improved with tularemia treatment. We present a rare case of hepatic involvement of tularemia in a child. Clinicians should be suspicious of and evaluate for typhoidal tularemia in patients who present with prolonged fever and non-specific systemic symptoms, potentially with associated abdominal pain.
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Affiliation(s)
- Emine Kocabaş
- Çukurova University Faculty of Medicine, Departman of Pediatric Infection Disease. Adana, Turkey.
| | - Özlem Özgür Gündeşlioğlu
- Çukurova University Faculty of Medicine, Departman of Pediatric Infection Disease. Adana, Turkey.
| | - Merve Kılıç Çil
- Çukurova University Faculty of Medicine, Departman of Pediatric Infection Disease. Adana, Turkey.
| | - Ümmühan Çay
- Çukurova University Faculty of Medicine, Departman of Pediatric Infection Disease. Adana, Turkey.
| | - Figen Doran
- Çukurova University Faculty of Medicine, Departman of Pathology. Adana, Turkey.
| | - Süreyya Soyupak
- Çukurova University Faculty of Medicine, Departman of Radiology. Adana, Turkey.
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17
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Abstract
Background Syphilis is a common disease that has been researched and focused on for many years, however, syphilitic hepatitis has not been well-recognized. We report this case of syphilitic hepatitis with intrahepatic cholestasis and liver granulomas to make a deeper impression. Case presentation A 47-year-old male was admitted with jaundice and rashes. The laboratory examination showed abnormal liver enzymes with significant increases in ALP and GGT but mild increases in ALT and AST. His HBV surface antigen was weakly positive, with negative HIV antibody, HCV antibody, and undetectable HBV DNA. The rapid plasma reagin test and the Treponema pallidum particle assay tests for Syphilis were both positive. Abdominal ultrasonography and magnetic resonance cholangiopancreatography revealed the normal biliary tract, liver, and spleen. The liver pathological examination showed cholangiocyte inflammation and micro-granulomas with coagulation necrosis. After 2 months of benzathine penicillin treatment, his liver enzyme decreased rapidly and remained normal after 1-year of follow-up. Conclusions Increased liver enzymes, intrahepatic cholestasis and liver granulomas with well-response to antibiotics may provide clues for the diagnosis of syphilitic hepatitis.
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18
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Bevan R, Harrison PTC, Jeffery B, Mitchell D. Evaluating the risk to humans from mineral oils in foods: Current state of the evidence. Food Chem Toxicol 2019; 136:110966. [PMID: 31751646 DOI: 10.1016/j.fct.2019.110966] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 11/10/2019] [Accepted: 11/11/2019] [Indexed: 10/25/2022]
Abstract
Key issues around the evaluation of risks to humans from mineral oils in food and feedstuffs are discussed. MOHs (MOAH and MOSH) occur in food due to intentional use, contamination from environmental sources and during transport/processing, or through migration from food contact materials. Problems in setting and enforcing human health guidelines for MOH include uncertainty around MOH toxicity and the specialist expertise needed for analysis of complex food matrices. Currently, the method of choice for measuring mineral oils is LC-GC-FID, however some complex food matrices also require additional analytical techniques to differentiate between some naturally occurring hydrocarbons and those from other sources, including of petrogenic origin. This requires the skills of an experienced analyst. Significant toxicological gaps for MOHs prevent robust human health risk assessment and the derivation of guidance values. As food-grade mineral oils are virtually MOAH-free, the key issue explored here is the relevance to humans of liver (micro)granulomas observed in F344 rats following oral intake. Available data suggest that despite the ubiquitous nature of MOH in the human diet, the prevalence of liver lipogranulomas in the population is low. These are not associated with inflammation and based on current evidence are not considered of human health significance.
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Affiliation(s)
- R Bevan
- IEH Consulting Ltd, Nottingham, UK.
| | | | - B Jeffery
- Mars Global Food Safety Center, Beijing, PR China
| | - D Mitchell
- Mars Global Food Safety Center, Beijing, PR China
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19
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Abstract
Mycobacterium chimaera was identified as a species within the Mycobacterium avium complex in 2004. Until recently, it was predominantly seen in immunocompromised patients. In 2015, an outbreak of disseminated M. chimaera disease was described in European patients after undergoing open-heart surgery in which contaminated heater-cooler water units were used. Using whole genomic sequencing and phylogenetic analysis, investigators found a highly clonal outbreak from the German manufacturing site of the heater-cooler water units. This outbreak has now proven to be world-wide. Patients present with fever, fatigue, and weight loss months to many years after surgery. They are found to have systemic manifestations, including endocarditis, pancytopenia, renal dysfunction, chorioretinitis, and hepatitis. Preliminary reports suggest a high mortality rate despite aggressive treatment. In some patients, the predominant laboratory abnormalities are elevations in liver function tests, leading to diagnostic hepatobiliary work-ups, including liver biopsy. The pathologic changes in the liver have not yet been described. Herein, we report the clinicopathologic findings of the largest series of M. chimaera liver disease in the United States to date: 7 cases within a large, multihospital health care network. Five (71%) patients died of disease, despite aggressive treatment. Liver function test abnormalities were predominantly biliary: mean values of alkaline phosphate 288 U/L, aspartate aminotransferase 79 U/L, alanine aminotransferase 64 U/L. All 7 biopsies showed a consistent and characteristic dual pattern of injury: small, ill-formed collections of sinusoidal histiocytes with rare multinucleated giant cells, and scattered architectural changes of venous outflow obstruction. Two (29%) cases showed mild pericellular fibrosis. Nodular regenerative hyperplasia was seen in 2 (29%) cases, consistent with a sinusoidal/venous obstructive pattern of injury. We postulate that the sinusoidal location of the granulomas contributes to the venous obstructive changes. Recognition of this characteristic dual pattern of injury can allow pathologists to suggest the diagnosis and prompt the appropriate diagnostic and therapeutic interventions.
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20
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Sedki M, Fonseca N, Santiago P, Diaz L, Garcia-Buitrago M, Mirsaeidi M, Levy C. Hepatic Sarcoidosis: Natural History and Management Implications. Front Med (Lausanne) 2019; 6:232. [PMID: 31737633 PMCID: PMC6831521 DOI: 10.3389/fmed.2019.00232] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 10/03/2019] [Indexed: 12/19/2022] Open
Abstract
Introduction: Hepatic granulomas are common in patients with sarcoidosis, but clinically significant liver disease is uncommon and poorly studied. We aimed to characterize the frequency and clinical course of hepatic sarcoidosis in an ethnically diverse population. Methods: This is a retrospective study including all cases of hepatic sarcoidosis in a single center. The median follow-up time was 49 months (4–121). Cases were identified based on ICD-9 and ICD-10 codes for granulomatous hepatitis, sarcoidosis, and hepatic sarcoidosis. The Chi-square and Wilcoxon-signed rank tests were used as indicated to assess for differences between groups. Results: Of 286 patients with sarcoidosis, 27 had hepatic involvement; 78% were female and 48% African American. The most common pattern of liver tests abnormalities was cholestatic. Ten patients had clinically significant hepatic involvement: cirrhosis in seven (25.9%), portal hypertension in nine (33%), and portal vein thrombosis in one (3.7%). Sex, race, and ethnicity were not associated with an increased risk of hepatic involvement or symptomatic hepatic sarcoidosis. Most patients received medical treatment, most commonly oral glucocorticoids. At the end of the follow-up period, all patients were alive but two had undergone liver transplantation due to complications of hepatic sarcoidosis. Three patients with hepatic sarcoidosis had initially been classified as AMA-negative PBC. Conclusions: Hepatic sarcoidosis was found in 9.4% of patients with sarcoidosis and was clinically significant in 37% of those. Identifying and monitoring hepatic sarcoidosis is crucial given its potential complications.
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Affiliation(s)
- Mai Sedki
- Department of Internal Medicine, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Nicholas Fonseca
- Schiff Center for Liver Diseases, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Priscila Santiago
- Department of Internal Medicine, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Liege Diaz
- Division of Gastroenterology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Monica Garcia-Buitrago
- Department of Pathology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Mehdi Mirsaeidi
- Division of Pulmonology and Critical Care, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Cynthia Levy
- Division of Hepatology, University of Miami Miller School of Medicine, Miami, FL, United Statesxs
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21
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Fomin VV, Brovko MY, Kalashnikov MV, Sholomova VI, Rozina TP, Akulkina LA, Pershina AE, Yanakayeva AS, Nekrasova TP. Hepatic involvement in sarcoidosis. TERAPEVT ARKH 2019; 91:8-16. [PMID: 31094470 DOI: 10.26442/00403660.2019.04.000179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Sarcoidosis is a multisystem granulomatous disease of unknown etiology. Liver is frequently involved in the pathological process. Wide range of clinical manifestations can be seen: from asymptomatic lesion with normal liver function tests to cirrhosis with portal hypertension. Biopsy plays the key role in diagnosis of the hepatic sarcoidosis. It is essential for morphological diagnosis to exclude other causes of granulomatous liver disease, most often - primary biliary cholangitis. Nowadays there are no standard treatment protocols for patients with hepatic sarcoidosis.
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Affiliation(s)
- V V Fomin
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Faculty of Medicine, Department of Internal Medicine No.1, Moscow, Russia
| | - M Yu Brovko
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), E.M. Tareev Clinic of Internal Diseases, Moscow, Russia
| | - M V Kalashnikov
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Medical and Preventive Faculty, Department of Internal, Occupational Diseases and Rheumatology, Moscow, Russia
| | - V I Sholomova
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), E.M. Tareev Clinic of Internal Diseases, Moscow, Russia.,I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Medical and Preventive Faculty, Department of Internal, Occupational Diseases and Rheumatology, Moscow, Russia
| | - T P Rozina
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), E.M. Tareev Clinic of Internal Diseases, Moscow, Russia.,M.V. Lomonosov Moscow State University, Faculty of Base Medicine, Department of Internal Medicine, Moscow, Russia
| | - L A Akulkina
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), E.M. Tareev Clinic of Internal Diseases, Moscow, Russia
| | - A E Pershina
- M.V. Lomonosov Moscow State University, Faculty of Base Medicine, Department of Internal Medicine, Moscow, Russia
| | - A Sh Yanakayeva
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), E.M. Tareev Clinic of Internal Diseases, Moscow, Russia
| | - T P Nekrasova
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), A.I. Strukov Department of Pathological Anatomy, Moscow, Russia
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22
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Almogairen SM. Abatacept induced granulomatous hepatitis with a sarcoidosis- like reaction: a blinded trial in mice. BMC Pharmacol Toxicol 2019; 20:26. [PMID: 31064410 PMCID: PMC6503540 DOI: 10.1186/s40360-019-0303-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 04/22/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Abatacept is increasingly used for rheumatoid arthritis (RA) and juvenile idiophathic arthritis (JIA) treatment. However little is known about the risk of hepatotoxicity. The aim of this study was to determine whether the inhibition of the T cell CD28 receptor by abatacept results in acute hepatitis in BALB/c mice. METHODS Twenty BALB/c mice were studied. Ten mice received subcutaneous (SC) injection of abatacept (0.25mg per 25g body weight per 0.03 ml normal saline) at 0, 2, 4 and 8 weeks. For the control group, 10 mice received a SC injection of normal saline (NS) (0.03 ml). At the 10th week post injection, the mice were sacrificed, and histopathological studies were conducted. RESULTS Of the abatacept-treated group, 3/10 mice died. Liver histology for the abatacept-treated group showed that 6/7 displayed histopathological changes in the lobular cellular infiltrates of eosinophils, lymphocytes and histiocytes, in addition to granuloma formation. In contrast, only minimal inflammation was observed in 3/10 mice in the control group (p=0.036). CONCLUSION Abatacept may play a role in inducing granulomatous hepatitis with a sarcoidosis-like reaction. Additional data including transaminases, antinuclear antibodies (ANA), Antimitochondrial antibodies (AMA) and other auto antibodies should be tested.
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Affiliation(s)
- Sultan M Almogairen
- Rheumatology Division, Department of Medicine, College of Medicine, King Saud University, P O Box 2925, Riyadh, 11461, Saudi Arabia.
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23
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Santosa A, Wong CF, Koh LW. Multisystemic sarcoidosis-important lessons learnt from one of the great imitators. BMJ Case Rep 2019; 12:e227929. [PMID: 30904884 PMCID: PMC6453389 DOI: 10.1136/bcr-2018-227929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2019] [Indexed: 12/29/2022] Open
Abstract
We report a case of a woman who was admitted with a suspicion of metastatic malignancy of unknown primary origin. A few months prior to her admission, she presented to a rheumatologist with acute anterior uveitis, psoriasiform rashes and polyarthritis. A diagnosis of psoriatic arthropathy was made and she was treated accordingly. Soon after she presented with persistent back and right upper quadrant abdominal pain for which she had a CT scan done with evidence of hilar lymphadenopathy, liver hypodensities and lytic-sclerotic bone lesions. She was referred to our hospital for further investigations and management. After re-exploring her clinical presentation and further investigations (including a liver biopsy), a diagnosis of multisystemic sarcoidosis with ocular, reticuloendothelial, hepatic and skeletal involvement was made. The patient was started on systemic glucocorticoids and second line immunosuppressants and demonstrated significant clinical improvement with resolution of her liver granulomata on imaging and improvement in her back pain. The case illustrates the importance of a thorough clinical assessment, review of investigations and an open mind in the evaluation of a patient.
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Affiliation(s)
- Anindita Santosa
- Medicine (Rheumatology), Changi General Hospital, Singapore, Singapore, Singapore
| | | | - Li Wearn Koh
- Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore, Singapore
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24
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Lerner AM, Bennett JE, Pittaluga S, Khil PP, Youn JH, Fahle GA, Frank KM, Dekker JP, Jerussi TD, Sun C, Wiestner A, Gea-Banacloche J. Protracted course of disseminated adenovirus disease with necrotizing granulomas in the liver. Diagn Microbiol Infect Dis 2019; 94:180-182. [PMID: 30679057 DOI: 10.1016/j.diagmicrobio.2018.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 11/23/2018] [Accepted: 12/26/2018] [Indexed: 02/06/2023]
Abstract
A 52- year-old male with chronic lymphocytic leukemia was hospitalized with disseminated adenovirus disease. More than a month following recovery, hepatic necrotizing granulomas secondary to adenovirus were found. This case illustrates the protracted course that adenovirus disease may take and emphasizes an unusual presentation with hepatic necrotizing granulomas.
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Affiliation(s)
- Andrea M Lerner
- Division of Clinical Research, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), 9000 Center Drive, Bethesda, MD 20892, USA.
| | - John E Bennett
- Laboratory of Clinical Immunology and Microbiology, NIAID, NIH, 9000 Center Drive, Bethesda, MD 20892, USA
| | - Stefania Pittaluga
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute (NCI), NIH, 9000 Center Drive, Bethesda, MD 20892, USA
| | - Pavel P Khil
- Microbiology Service, Department of Laboratory Medicine, NIH, 9000 Center Drive, Bethesda, MD 20892, USA
| | - J H Youn
- Microbiology Service, Department of Laboratory Medicine, NIH, 9000 Center Drive, Bethesda, MD 20892, USA
| | - Gary A Fahle
- Microbiology Service, Department of Laboratory Medicine, NIH, 9000 Center Drive, Bethesda, MD 20892, USA
| | - Karen M Frank
- Microbiology Service, Department of Laboratory Medicine, NIH, 9000 Center Drive, Bethesda, MD 20892, USA
| | - John P Dekker
- Microbiology Service, Department of Laboratory Medicine, NIH, 9000 Center Drive, Bethesda, MD 20892, USA
| | - Theresa D Jerussi
- Office of Patient Safety and Clinical Quality, Clinical Center, NIH, 9000 Center Drive, Bethesda, MD, 20892, USA
| | - Clare Sun
- Hematology Branch, National Heart, Lung, and Blood Institute (NHLBI), NIH, 9000 Center Drive, Bethesda, MD 20892, USA
| | - Adrian Wiestner
- Hematology Branch, National Heart, Lung, and Blood Institute (NHLBI), NIH, 9000 Center Drive, Bethesda, MD 20892, USA
| | - Juan Gea-Banacloche
- Division of Infectious Diseases, Mayo Clinic Hospital, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
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25
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Toxic effects of mineral oil saturated hydrocarbons (MOSH) and relation to accumulation in rat liver. Food Chem Toxicol 2019; 123:431-442. [DOI: 10.1016/j.fct.2018.11.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 10/09/2018] [Accepted: 11/09/2018] [Indexed: 01/09/2023]
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26
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Huang J, Lin S, Wan B, Zhu Y. A Systematic Literature Review of Syphilitic Hepatitis in Adults. J Clin Transl Hepatol 2018; 6:306-309. [PMID: 30271743 PMCID: PMC6160304 DOI: 10.14218/jcth.2018.00003] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 02/12/2018] [Accepted: 03/03/2018] [Indexed: 01/19/2023] Open
Abstract
Syphilitic hepatitis in adults is not frequently found in the population and is easily misdiagnosed. The incidence of viral hepatitis is increasing year by year, concomitantly increasing the importance of obtaining a systematic understanding of the clinical features and treatment strategies for this disease. There is, however, a lack of published definitive data regarding the clinical characteristics, diagnosis and standard treatment options for this disease. Searches were made using the MEDLINE database of PubMed and OVID for syphilitic hepatitis publications from 1951 to 2017 in an attempt to analyze and summarize the clinical characteristics.
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Affiliation(s)
- Jiaofeng Huang
- Liver Research Center of the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Su Lin
- Liver Research Center of the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Bo Wan
- Institute of Neurology, University College London, London, UK
| | - Yueyong Zhu
- Liver Research Center of the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
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27
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Gaspar R, Andrade P, Silva M, Peixoto A, Lopes J, Carneiro F, Liberal R, Macedo G. Hepatic granulomas: a 17-year single tertiary centre experience. Histopathology 2018; 73:240-246. [PMID: 29603759 DOI: 10.1111/his.13521] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 03/22/2018] [Indexed: 01/08/2023]
Abstract
AIMS Hepatic granulomas have an estimated prevalence of 5% in liver biopsies, with a wide range of aetiologies globally. Our aim was to assess the clinical relevance, presenting features and underlying aetiology in a non-transplant, tertiary referral centre from a western country. METHODS AND RESULTS This was a retrospective, single-centre review of clinical, laboratory and histological data including all adult patients for whom a liver biopsy was performed from January 1998 to December 2014. A total of 297 cases with hepatic granulomas were found in 9374 biopsies, but 57 were excluded from analysis either because they were lipogranulomas or the biopsy/aetiological work-up had not been performed at our institution. Overall, the most common aetiology was tuberculosis (35.8%), followed by primary biliary cholangitis (PBC) - 15.0%. In 30 patients (12.5%) granulomas were classified as idiopathic. From 1998 to June 2006 there were 147 granulomas in 5304 biopsies (2.8%), a frequency that did not change significantly compared to the period from July 2006 to December 2014 (93 granulomas in 4070 biopsies, 2.3%, P > 0.05). However, for the majority of cases (61.9%) there was a shift in granuloma aetiology during the former time-period that infectious diseases were responsible, whereas in the latter, autoimmune liver diseases (43%) were the main aetiology. In addition, while three cases of drug-induced granulomas were found from 1998 to June 2006, we report two cases in the second time-period. CONCLUSIONS Hepatic granulomas can result from various infectious and non-infectious diseases. During recent years, an epidemiological shift regarding granuloma aetiology was observed, from systemic infectious diseases to non-infectious, mainly immune-mediated primary liver disorders. With an appropriate work-up the aetiology can be identified in the vast majority of cases (~90%), rendering its histological identification and characterisation essential, as disease-specific therapies are becoming available.
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Affiliation(s)
- Rui Gaspar
- Gastroenterology Department, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Patricia Andrade
- Gastroenterology Department, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Marco Silva
- Gastroenterology Department, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Armando Peixoto
- Gastroenterology Department, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Joanne Lopes
- Pathology Department, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Fatima Carneiro
- Pathology Department, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Porto, Portugal.,Instituto de Patologia e Imunologia Molecular da Universidade do Porto (Ipatimup, and i3S-Instituto de Investigação e Inovação em Saúde), Universidade do Porto, Porto, Portugal
| | - Rodrigo Liberal
- Gastroenterology Department, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Porto, Portugal
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28
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Lewis J. Histopathology of granulomatous liver disease. Clin Liver Dis (Hoboken) 2018; 11:77-80. [PMID: 30992794 PMCID: PMC6385944 DOI: 10.1002/cld.695] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 12/18/2017] [Accepted: 12/31/2017] [Indexed: 02/04/2023] Open
Affiliation(s)
- Jason Lewis
- Department of PathologyMayo Clinic FloridaJacksonvilleFL
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29
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Abstract
Despite advances in the understanding of the pathophysiology, granulomatous diseases remain a diagnostic challenge for the clinician as well as for the pathologist. However, establishing the correct diagnosis of these diseases is a crucial prerequisite of targeted therapy. It is particularly essential to distinguish between an infectious and a non-infectious cause, since anti-infectious and anti-inflammatory or immunosuppressive approaches are opposing. Failure to establish the correct diagnosis can lead to adverse consequences for the patient. An interdisciplinary approach and a critical assessment of clinical, laboratory-chemical, microbiological, imaging, and anatomical-pathological findings are crucial for the evaluation of granulomatous disorders. This overview summarizes important landmarks and their value in the interplay of arriving at the correct diagnosis.
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30
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Yan YQ, Su ZB, Zheng ZY. Disseminated granulomatous hepatitis: A case. Shijie Huaren Xiaohua Zazhi 2017; 25:2825-2828. [DOI: 10.11569/wcjd.v25.i31.2825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Disseminated granulomatous hepatitis is a form of multifocal, disseminated epithelioid granulomatous hepatitis. Granulomatous hepatitis is mostly caused by infection and rarely observed in non-infectious diseases. At present, there have been very few reports of disseminated granulomatous hepatitis in China. Here we report a case of disseminated granuloma hepatitis and analyze its clinical and pathological characteristics and etiology, with an aim to enhance the awareness of this condition.
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Affiliation(s)
- Yong-Qin Yan
- Department of Pathology, Fuzhou General Hospital of Chinese PLA, Fuzhou 350025, Fujian Province, China
| | - Zhe-Bin Su
- Department of Pathology, Fuzhou General Hospital of Chinese PLA, Fuzhou 350025, Fujian Province, China
| | - Zhi-Yong Zheng
- Department of Pathology, Fuzhou General Hospital of Chinese PLA, Fuzhou 350025, Fujian Province, China
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31
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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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32
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Adenuga D, Goyak K, Lewis RJ. Evaluating the MoA/human relevance framework for F-344 rat liver epithelioid granulomas with mineral oil hydrocarbons. Crit Rev Toxicol 2017; 47:750-766. [DOI: 10.1080/10408444.2017.1319336] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- David Adenuga
- ExxonMobil Biomedical Sciences, Inc., Annandale, NJ, USA
| | - Katy Goyak
- ExxonMobil Biomedical Sciences, Inc., Annandale, NJ, USA
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33
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Eosinophil-rich granuloma of the liver. Tzu Chi Med J 2017; 28:183-184. [PMID: 28757755 PMCID: PMC5442900 DOI: 10.1016/j.tcmj.2016.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 04/25/2016] [Accepted: 05/30/2016] [Indexed: 12/02/2022] Open
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34
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Can NT, Grenert JP, Vohra P. Concomitant Epstein-Barr Virus-associated smooth muscle tumor and granulomatous inflammation of the liver. Pathol Res Pract 2017; 213:1306-1309. [PMID: 28756985 DOI: 10.1016/j.prp.2017.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 05/12/2017] [Accepted: 07/02/2017] [Indexed: 11/17/2022]
Abstract
Epstein-Barr Virus-associated smooth muscle tumor (EBV-SMT) is a rare mesenchymal tumor typically seen in immunocompromised patients. Here, we report a case of EBV-SMT and associated granulomatous inflammation in the liver of a 32-year-old man with history of human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS). To our knowledge, an association of these two lesions has not been previously reported. We review the literature and discuss pathogenesis, differential diagnosis and immunohistochemical (IHC) stains helpful for the diagnosis of this rare entity. Finally, we consider possible explanations for the concomitant presence of these lesions.
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Affiliation(s)
- Nhu Thuy Can
- Department of Pathology, University of California, San Francisco, CA, USA
| | - James P Grenert
- Department of Pathology, University of California, San Francisco, CA, USA
| | - Poonam Vohra
- Department of Pathology, University of California, San Francisco, CA, USA.
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35
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Gounder L, Moodley P, Drain PK, Hickey AJ, Moosa MYS. Hepatic tuberculosis in human immunodeficiency virus co-infected adults: a case series of South African adults. BMC Infect Dis 2017; 17:115. [PMID: 28148232 PMCID: PMC5288843 DOI: 10.1186/s12879-017-2222-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 01/25/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although Mycobacterium tuberculosis (TB) infection may cause extrapulmonary disease in HIV-infected adults, HIV-associated hepatic TB has been poorly characterized. Our objective was to describe hepatic TB in HIV-infected adults. METHODS Retrospective study of patients diagnosed with hepatic TB from 2005-2012 at Infectious Diseases Clinic, King Edward VIII Hospital, Durban, South Africa. RESULTS Among twenty cases of histology-confirmed HIV-associated hepatic TB, median CD4 count was 47 cells/μl (inter-quartile range 27-107 cells/μl) and 75% (15/20) of patients had pre-existing pulmonary TB. The most frequent clinical finding was hepatomegaly (85%). Liver enzyme abnormalities included elevated alkaline phosphatase (median 456 u/L, inter-quartile range 322-1,043 u/L) and gamma-glutamyltransferase (median 422 u/L, inter-quartile range 235-736 u/L). Acid-fast bacilli were cultured from liver tissue in 30% (6/20) of patients; 25% (5/20) identified as TB. With standard anti-TB therapy, liver enzymes improved within six months in 92% (11/12) of patients. One year after diagnosis, twelve patients resolved clinically, two patients developed drug-resistant TB and six patients died. CONCLUSION In our case series of HIV-infected patients, hepatic TB occurred in patients with severe immunosuppression, who presented with hepatomegaly and abnormal liver enzymes. More than half of patients had resolution of liver function by six months however the 12-month mortality remained high.
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Affiliation(s)
- Lilishia Gounder
- Department of Infectious Diseases, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
- Department of Virology, National Health Laboratory Service, Inkosi Albert Luthuli Central Hospital, 800 Bellair Road, Durban, Mayville, 4058, South Africa.
| | - Pravikrishnen Moodley
- Department of Virology, National Health Laboratory Service, Inkosi Albert Luthuli Central Hospital, 800 Bellair Road, Durban, Mayville, 4058, South Africa
| | - Paul K Drain
- Department of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, USA
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | | | - Mahomed-Yunus S Moosa
- Department of Infectious Diseases, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- King Edward VIII Hospital, Durban, South Africa
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36
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Ko M, Ishikawa T, Imai M, Sato H, Nozawa Y, Sano T, Iwanaga A, Seki K, Honma T, Ogawa H, Tsubono T, Nemoto T, Takeda K, Nishikura K, Ishihara N, Yoshida T, Kamimura T. A case of hepatic inflammatory pseudo-tumor of the liver mimicking a metastatic tumor of colon and/or bile duct cancer. KANZO 2017; 58:241-247. [DOI: 10.2957/kanzo.58.241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Affiliation(s)
- Masayoshi Ko
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital
| | - Toru Ishikawa
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital
| | - Michitaka Imai
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital
| | - Hiroki Sato
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital
| | - Yujiro Nozawa
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital
| | - Tomoe Sano
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital
| | - Akito Iwanaga
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital
| | - Keiichi Seki
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital
| | - Terasu Honma
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital
| | - Hiroshi Ogawa
- Department of Surgery, Saiseikai Niigata Daini Hospital
| | | | - Takeo Nemoto
- Department of Radiology, Saiseikai Niigata Daini Hospital
| | - Keiko Takeda
- Department of Radiology, Saiseikai Niigata Daini Hospital
| | - Ken Nishikura
- Department of Pathology, Saiseikai Niigata Daini Hospital
| | | | - Toshiaki Yoshida
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital
| | - Tomoteru Kamimura
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital
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37
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Putra J, Fiel MI. Hepatocellular Carcinoma With Foamy Histiocyte-Like Component. Int J Surg Pathol 2016; 25:166-167. [PMID: 27682514 DOI: 10.1177/1066896916671593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Juan Putra
- 1 Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Maria Isabel Fiel
- 1 Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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38
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Culver EL, Watkins J, Westbrook RH. Granulomas of the liver. Clin Liver Dis (Hoboken) 2016; 7:92-96. [PMID: 31041038 PMCID: PMC6490265 DOI: 10.1002/cld.544] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 02/10/2016] [Indexed: 02/04/2023] Open
Affiliation(s)
- Emma L. Culver
- Sheila Sherlock Liver CentreRoyal Free HospitalLondonUnited Kingdom
| | - Jennifer Watkins
- Department of HistopathologyRoyal Free HospitalLondonUnited Kingdom
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