Abstract
A 43-year-old man with a history of excessive alcohol intake was admitted to our hospital on May 2001 with a 1-month history of anorexia and nausea. On admission, he was deeply jaundiced, with a palpable liver margin four fingerbreadths beneath the right costal margin. Although the patient stopped drinking after admission, jaundice rapidly progressed and marked elevation of white blood cell count (31, 840/mm3) was observed. Severe alcoholic hepatitis was diagnosed. After the combined treatment of plasma exchange with a brief course of steroids, white blood cell count and serum bilirubin levels decreased without recurrence. Liver biopsy demonstrated a widespread fibrosis with mild inflammatory infiltrate, consistent with the recovery phase of severe alcoholic hepatitis. Endotoxin and inflammatory cytokines are important mediators in severe alcoholic hepatitis and measures against hypercytokinemia are important. This case suggests that treatment combining plasma exchange and a brief course of steroid therapy may be beneficial for improvement of severe alcoholic hepatitis.
