Kanzo

Case Reports

A non-Hodgkin lymphoma patient with reactivation of HBV during chemotherapy and emergence of a YMDD-motif mutant on lamivudine, eventually controlled by adfovil dipovoxil

Takeshi Terashima, Kuniaki Arai, Takuya Komura, Hiroshi Iida, Takashi ...

Article type: Case Report
2007 Volume 48 Issue 7 Pages 309-316
Published: 2007
Released on J-STAGE: July 30, 2007

DOIhttps://doi.org/10.2957/kanzo.48.309

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A 56-year-old man underwent chemotherapy for non-Hodgkin lymphoma (NHL) including rituximab, a chimeric monoclonal anti-CD20 antibody. He was a hepatitis B virus (HBV) carrier, and the HBV-DNA in his serum increased during the chemotherapy, but returned to an undetectable level as soon as he was administrated lamivudine. He got complete remission as for NHL and started rituximab alone for adjuvant therapy. He then had hepatitis caused by HBV reactivation just after administration of rituximab. A YMDD (M204V) mutant was detected from him, so we prescribed adefovil dipivoxil added to lamivudine. His hepatitis was slightly prolonged, but HBV-DNA was reduced gradually, and hepatitis was improved. He maintains normal transaminase levels with undetectable HBV-DNA now at 15 months after the breakthrough hepatitis.

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Fatal Aeromonas hydrophila infection in a patient with liver cirrhosis

Kazuhiro Suzumura, Takaaki Sugimoto, Jiro Fujimoto

Article type: Case Report
2007 Volume 48 Issue 7 Pages 317-321
Published: 2007
Released on J-STAGE: July 30, 2007

DOIhttps://doi.org/10.2957/kanzo.48.317

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A 66-year-old man with hepatitis B virus-related liver cirrhosis was admitted to our hospital because of fever and vomiting. We diagnosed a cholecystitis and treated with antibiotics. He developed bleeding lesions and bullae on his bilateral lower extremities one day after admission. Gram-negative rods were detected from the bulla. CT showed an air density in the muscle of lower extremity, leading to a diagnosis of necrotic fascitis, and we performed amputations of the bilateral lower extremities. In spite of intensive care, he died of sepsis one day after operation. Aeromonas hydrophila was detected in the bulla, blood and fascia afterward. A. hydrophila infection is known to become very serious in immuno-compromised hosts. We here report a fatal case of A. hydrophila infection that occurred in a patient with decompensated liver cirrhosis.

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A case of portopulmonary hypertension successfully treated by balloon-occluded retrograde transvenous obliteration and home oxygen therapy

Kanako Yamamoto, Kazunori Kawaguchi, Kaheita Kakinoki, Kazuya Kitamura ...

Article type: Case Report
2007 Volume 48 Issue 7 Pages 322-330
Published: 2007
Released on J-STAGE: July 30, 2007

DOIhttps://doi.org/10.2957/kanzo.48.322

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A 71-year-old man was admitted to our hospital due to dyspnea on effort and recurrent esophageal varices. In right heart catheterization, mean pulmonary arterial pressure was raised to 36mmHg, suggesting pulmonary arterial hypertension. He had hepatitis C virus-related cirrhosis of the liver and portal hypertension, but had no other causes of pulmonary arterial hypertension, leading to the diagnosis of portopulmonary hypertension. He had undergone balloon-occluded retrograde transvenous obliteration for esophageal varices four months ago, and it resulted in a 9.3%-reduction of the mean pulmonary arterial pressure, estimated by echo cardiography, but he was still suffering from dyspnea and hypoxia. We then introduced home oxygen therapy, which showed an effect of further 20.5%-reduction of the mean pulmonary arterial pressure four months later. Thus our present case provides some important clues to pathogenesis as well as treatment of portopulmonary hypertension.

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Acute tumor lysis syndrome associated with transcatheter hepatic arterial chemoembolization therapy of hepatocellular carcinoma: a case report

Shohei Sakamoto, Masatora Haruno, Hirofumi Tanaka, Kazuta Nakasuga, Ju ...

Article type: Case Report
2007 Volume 48 Issue 7 Pages 331-337
Published: 2007
Released on J-STAGE: July 30, 2007

DOIhttps://doi.org/10.2957/kanzo.48.331

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Tumor lysis syndrome (TLS) is rare in the treatment of hepatocellular carcinoma (HCC), but here we report a case of acute TLS associated with transcatheter hepatic arterial chemoembolization (TACE) for HCC, in a hepatitis C virus-infected 71-year-old woman with a serum alpha-fetoprotein level at 5,688ng/mL. She underwent TACE therapy with an emulsified mixture of Lipiodol, farmorubicin and mitomycin C, together with gelatin sponge particles for local HCC relapse. The patient developed signs of TLS, including acute renal failure, immediately after the procedure of TACE. Within the second day of TACE, laboratory examinations showed metabolic acidosis, hyperkalemia (7.4mEq/L), and increased serum levels of creatinine (3.7mg/dL) and uric acid (10.5mg/dL), leading to the diagnosis of acute renal failure associated with acute TLS. The patient was then treated with continuous venovenous hemodiafiltration (CVVHDF). The patient quickly improved with normalization of biochemical markers, and left our hospital on her feet one month later.

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Short Communication

An easy ELISA for detecting antibodies to hepatitis E virus irrespective of animal species

Kazuaki Takahashi, Natsumi Abe, Kojiro Michitaka, Naoto Kitajima, Taka ...

Article type: Short Communication
2007 Volume 48 Issue 7 Pages 338-340
Published: 2007
Released on J-STAGE: July 30, 2007

DOIhttps://doi.org/10.2957/kanzo.48.338

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A partial ORF2 protein of hepatitis E virus (HEV) was expressed in E. coli, purified, and used as solid-phase ligand as well as tracer-ligand labeled with peroxidase, in an antigen-antibody-antigen Sandwich ELISA system, to detect antibodies to HEV. This new system showed higher sensitivity of detecting anti-HEV than conventional ELISA system which needs specific antibodies against IgG, IgM, or IgA of concerned animal species as tracer-ligands. Since our new ELISA system is universally applicable to any animal species without needing specific antibodies, it will be useful in further elucidating the animal reservoirs of HEV.

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Rapid Communication

Prolongation of the standard 48-week regimen of peginterferon plus ribavirin treatment by 4-12 weeks favors chronic hepatitis C patients with early virological response

Hiroki Ikeda, Michihiro Suzuki, Chiaki Okuse, Minoru Kobayashi, Fumio ...

Article type: Rapid Communication
2007 Volume 48 Issue 7 Pages 341-342
Published: 2007
Released on J-STAGE: July 30, 2007

DOIhttps://doi.org/10.2957/kanzo.48.341

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Regimen of peginterferon alpha 2b plus ribavirin (PEG/R) for chronic hepatitis C patients could be tailored according to how early HCV viremia disappears after initiation of the treatment. We focused on patients who showed rapid or early virological response: i.e., HCV in serum turned undetectable at week 4 (rapid virological response, RVR), or at week 8-12 (early virological response, EVR). The patients with RVR (n=4) received PEG/R for 48 weeks, while the patients with EVR (n=28) received PEG/R for 52 weeks (in those with VR at week 8) or for 56-60 weeks (in those with VR at week 12), resulting in that 4 of the RVR patients (100%) and 22 of the EVR patients (78.6%) acquired sustained virological response (SVR). The rate of SVR in EVR patients was higher than that so far reported for patients who received the standard 48-week regimen of PEG/R treatment. Meanwhile, the RVR patients showed a satisfactory SVR rate even with the 48-week regimen. Thus our present results suggest that the duration of PEG/R treatment should depend on how early the virological response occurs in the concerned patient.

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