Kanzo

Case Reports

A case of acute hepatitis A histologically proven as giant cell hepatitis

Makoto OKADA, Hayato SANEFUJI, Jiro WATANABE, Takeaki SATOH, Makoto NA ...

Article type: Case Report
2005 Volume 46 Issue 11 Pages 641-646
Published: 2005
Released on J-STAGE: November 24, 2006

DOIhttps://doi.org/10.2957/kanzo.46.641

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A 75-year-old female was admitted to our hospital because of nausea, right hypochondralgia and the development of liver injury (AST 152 IU/l, ALT 206 IU/l). She was diagnosed as acute hepatitis A on the basis of positive IgM anti-HA in serum. The ALT levels showed prolonged abnormality subsequent to the peak value of 833 IU/l on the 14th hospital day. The liver biopsy findings on the 37th hospital day revealed typical features of giant cell hepatitis. Considering the persistence of her abnormal liver function tests, the second liver biopsy was performed on the 85th hospital day. Although the findings were similar to those of the previous biopsy, the giant cells were less in number. The ALT levels returned to normal after a prolonged clinical course of six months.

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A domestic case of acute sporadic hepatitis E first identified in Toyama prefecture

Satoshi ODA, Yoshinari ATARASHI, Yukihiro SHIMIZU, Masaya IWAMOTO, Hir ...

Article type: Case Report
2005 Volume 46 Issue 11 Pages 647-652
Published: 2005
Released on J-STAGE: November 24, 2006

DOIhttps://doi.org/10.2957/kanzo.46.647

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Recently, sporadic acute hepatitis E patients who had no history of travel to endemic areas were increased in Japan. It became clear that these hepatitis cases were caused by Japan-indigenous HEV strains of each local area. We experienced a case of sporadic acute hepatitis E. The patient was a 50-year-old male who did not have history of travel, blood transfusion, sexual intercourse and ingestion of uncooked meat. He had fever and general malaise. He consulted a doctor and was pointed out marked liver dysfunction. Then, he was introduced and admitted to our hospital. We detected HEV-RNA and diagnosed him as acute hepatitis E. The HEV isolate belongs to genotype III, and have never been determined previously. Hepatitis E virus is distributed broadly in Japan, but the routes of infection are not clarified in the most cases. Further studies were required to make clear the routes of HEV infection.

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A Case of Intractable Hepatic Hydrothorax treated by Pleuro-Venous Shunt

Masaru INAGAKI, Syunsuke TANABE, Ryousuke YOSHIDA, Norifumi ARIKI, You ...

Article type: Case Report
2005 Volume 46 Issue 11 Pages 653-657
Published: 2005
Released on J-STAGE: November 24, 2006

DOIhttps://doi.org/10.2957/kanzo.46.653

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A 67-year-old woman with type C liver cirrhosis was hospitalized to our hospital for hepatic ascites and pleural effusion. Ascites improved with diuretics, but pleural effusion was intractable. Chest-X-ray films showed a massive pleural effusion in right hemithorax. The patient suffered from dyspnea in spite of repeated thoracentesis. A pleuro-venous shunt was inserted. Initially, pleural effusion was unchangeable, but subsequently decreased by increasing pumping times and mandatory thoracentesis. Finally, pleural effusion resolved and symptoms improved. Chest-X-ray films showed a full expansion of right lung and a few pleural effusion. Pleuro-venous shunting may provide satisfactory palliation and improve quality of life for intractable hepatic pleural effusions.

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Acute liver damage following ingestion of sea hare eggs

Keisuke ARIO, Toshihiko MIZUTA, Miyuki YATSUDA, Takanori KUMAGAI, Yasu ...

Article type: Case Report
2005 Volume 46 Issue 11 Pages 658-662
Published: 2005
Released on J-STAGE: November 24, 2006

DOIhttps://doi.org/10.2957/kanzo.46.658

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A 13-year-old boy developed continuous vomiting and acute liver damage after eating fresh sea hare (Aplysia kurodai) eggs. A blood test on admission showed 661 IU/l of AST and 1186 IU/l of ALT. There was no factor, such as hepatitis virus, alcohol or drug intake that may have caused the liver damage; thus, we diagnosed acute liver damage associated with ingestion of sea hare eggs. Symptoms and laboratory data improved with rest, fluid therapy and intravenous injection of glyzirrhizin. He was discharged without any complications after 18 days. Microscopic findings of the liver revealed scattered hepatocyte necrosis with infiltration of lymphocytes and neutrophils. Some marine mollusks reportedly contain toxic substances as a self-defense system. The sea hare, known as “Amefurashi” in Japanese, is commonly found along the rocky seashore facing the sea in Japan. Its eggs appear eatable but contain a cytotoxic substance, aplysianin, which can cause hepatic disorders.

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Short Communications

Comparison of the Prevalence of Hepatitis A and E Virus Infections among Patients infected with Human Immunodeficiency Virus Type 1 in Japan

T Shibayama, G Masuda, A Ajisawa, Y Gotanda, A Yoshikawa, H Mizoguchi, ...

Article type: Short Communication
2005 Volume 46 Issue 11 Pages 663-664
Published: 2005
Released on J-STAGE: November 24, 2006

DOIhttps://doi.org/10.2957/kanzo.46.663

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We examined the prevalence of hepatitis A virus (HAV) and hepatitis E virus (HEV) infections among 280 Japanese patients infected with human immunodeficiency virus type 1 (HIV) and among 1,000 apparently healthy blood donors as a control. The prevalence of antibody to HAV was significantly higher among the HIV-infected patients than among the healthy donors (25.4% vs. 19.0%, P=0.025). When restricted to subjects aged <50 years, HAV antibody was detected significantly more frequently among the patients than among the donors (15.8% vs. 0.8%, P<0.0001). On the contrary, the prevalence of HEV antibody among the patients was almost equal to that among the donors (12.5% and 10.6%, respectively). HAV and HEV infections among HIV-infected patients deserve further studies.

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A case of diaphragmatic hernia induced by percutaneous radiofrequency ablation under the artificial pleural effusion for the hepatocellular carcinomas after 13 month period

K Kawai, Y Yata, K Hirano, S Yasumura, H Kudo, K Tajiri, Y Tokimitsu, ...

Article type: Short Communication
2005 Volume 46 Issue 11 Pages 665-666
Published: 2005
Released on J-STAGE: November 24, 2006

DOIhttps://doi.org/10.2957/kanzo.46.665

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A 84-year-old man who had been treated with percutaneous radiofrequency ablation (PRFA) under the artificial pleural effusion for hepatocellular carcinoma in the liver S8 was admitted to our hospital 13 months later from PRFA because of severe abdominal pain and vomiting. Plain CT revealed a diaphragmatic hernia with slided small intestine into the right thoracic cavity. We diagnosed the case as ileus with diaphragmatic hernia caused by PRFA. Although he was treated conservatively, he died from sepsis based on the ileus on the 11th hospital day. It was suggested PRFA close to the diaphragm induced diaphragmatic hernia 13 months later from PRFA procedure. In cases of HCC locating at sites adjacent to surrounding organs such as the diaphragm, gall bladder, or intestine, careful PRFA procedure and follow-up observation are necessary. The numbers of late complications including this case may increase by the accumulation of PRFA cases and longer-term observation.

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