Kanzo
Online ISSN : 1881-3593
Print ISSN : 0451-4203
ISSN-L : 0451-4203
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Volume 53, Issue 4
Displaying 1-7 of 7 articles from this issue
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Case Reports
  • A case of senile woman diagnosed with autoimmune hepatitis, accompanied by hepatitis A virus infection
    Keisuke Yokohama, Shinya Fukunishi, Atsushi Takeshita, Akira Asai, Hid ...
    Article type: Case Report
    2012 Volume 53 Issue 4 Pages 195-200
    Published: 2012
    Released on J-STAGE: April 27, 2012
    DOIhttps://doi.org/10.2957/kanzo.53.195
    JOURNAL FREE ACCESS
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    An 80-year-old woman visited our department because she was told to have impaired hepatic function by a local doctor. At presentation, AST (423 IU/l), ALT (222 IU/l), ALP (481 IU/l) and T-Bil (6.7 mg/dl) were all elevated, with a positive antinuclear antibody test (1 : 160). IgG was increased to 3238 mg/dl, and the IgM-HA antibody test was positive. The total score for the diagnostic scoring system developed by the International Autoimmune Hepatitis Group was 12, corresponding to a "probable" diagnosis. Thus, AIH was suspected as the underlying cause. The RT-PCR analysis of her serum sample revealed HAV-RNA, suggesting infection with hepatitis A virus (HAV). She was asked to take bed rest and observed, but AST and ALT remained elevated. A liver biopsy revealed histopathological findings consistent with a diagnosis of AIH. Oral predonisolone was initiated, which resulted in a rapid improvement in liver function. Here, we report this case of acute exacerbation of AIH, accompanied by HAV infection, in a senile woman.
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  • Sustained virological response against hepatitis C virus in a patient with Down's syndrome treated with interferon-β
    Toshiya Matsuda, Shinya Furukawa, Yuki Yokomoto, Yosuke Abe, Kohei Tak ...
    Article type: Case Report
    2012 Volume 53 Issue 4 Pages 201-205
    Published: 2012
    Released on J-STAGE: April 27, 2012
    DOIhttps://doi.org/10.2957/kanzo.53.201
    JOURNAL FREE ACCESS
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    A woman with Down's syndrome who developed liver damage due to hepatitis C virus (HCV) infection following surgery in childhood to treat a ventricular septal defect was treated with anti-HCV therapy. At age 25, liver function test suggested liver cirrhosis, and her heart condition was good. Since her prognosis was thought to be dependent on the course of the hepatitis C, she was treated with interferon (IFN) as an anti-HCV therapy. Achieving sustained virological response (SVR) in patients with Down's syndrome is known to be rare. However, she achieved SVR after 48 weeks of IFN-β monotherapy. Findings of HCV genotype 2a and a viral load of 3.2 log IU/mL are expected to be related to the good response to IFN, despite progressed liver fibrosis. Moreover, compliance with IFN-β administration was good. The prognosis for patients with Down's syndrome has recently improved. Anti-HCV therapy needs to be adapted for these patients, and IFN-β may be a suitable drug of choice.
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  • Two cases of fulminant hepatitis E occurred in Hakodate area 2010, suggesting infection with single source hepatitis E virus separated from small epidemic in Sapporo 2009
    Koji Ogawa, Yoshiya Yamamoto, Machiko Umemura, Jong-Hon Kang, Hidekats ...
    Article type: Case Report
    2012 Volume 53 Issue 4 Pages 206-215
    Published: 2012
    Released on J-STAGE: April 27, 2012
    DOIhttps://doi.org/10.2957/kanzo.53.206
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    In April 2010, two elder female patients presented fulminant hepatitis E in Hakodate city, Hokkaido, Japan. HEV strains identified in their blood sampled belonged to"new Sapporo strain"of Genotype 4 separated from the small epidemic happened in Sapporo 2009, showing significant similarity to each other by phylogenetic analysis. One patient of 63-year-old improved rapidly, however, another one of 73-year-old died from prolonged course of hepatitis. The quantified levels of HEV RNA in sera had promptly declined in the former, but those had sustained over 5 log copies/ml during 7 weeks in the latter. Lasting viremia in HEV infection might be associated with prolonged liver injury in the latter patient.
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  • A case of polymyositis concomitant with primary biliary cirrhosis simultaneously
    Jun Yokosuka, Tomohisa Ishikawa, Yutaka Nakao, Masayuki Saruta, Atsush ...
    Article type: Case Report
    2012 Volume 53 Issue 4 Pages 216-224
    Published: 2012
    Released on J-STAGE: April 27, 2012
    DOIhttps://doi.org/10.2957/kanzo.53.216
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    A 54-year-old woman experienced continuous proximal muscle weakness in both legs 2 months before. Her laboratory findings showed remarkably high levels of serum creatine kinase, gamma-glutamyl transferase, and alkaline phosphatase. Magnetic resonance imaging (MRI) showed a high-intensity signal area at the vastus medialis muscle. Muscle biopsy findings revealed mononuclear inflammatory cell infiltration in endomysial connective tissue. On ultrasonography, we observed fibrosis change in the liver parenchyma. Histological examination of the liver revealed chronic nonsuppurative destructive cholangitis. We diagnosed the patient with polymyositis concurrent with primary biliary cirrhosis. Immediately after the patient was administered prednisolone and ursodeoxycholic acid, her muscle weakness and clinical data improved. Only a few previous studies have reported cases of polymyositis concurrent with primary biliary cirrhosis. Therefore, we believe that our study is unique and particularly useful for further study of autoimmune liver diseases.
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  • A case of liver metastasis arising from gastric GIST 12 years after resection of primary GIST
    Junji Ueda, Hiroshi Yoshida, Yasuhiro Mamada, Nobuhiko Taniai, Masato ...
    Article type: Case Report
    2012 Volume 53 Issue 4 Pages 225-230
    Published: 2012
    Released on J-STAGE: April 27, 2012
    DOIhttps://doi.org/10.2957/kanzo.53.225
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    Liver is the most common site for metastasis of gastrointestinal stromal tumors (GIST). Liver metastasis often occurs within 2 years of a primary GIST resection. We describe an 80-year-old male patient with liver metastasis from a GIST resected 12 years ago. He was admitted for examination of the liver tumor, having previously had a partial gastrectomy for a gastric submucosal tumor. Abdominal enhanced CT revealed an irregular, heterogenous tumor, 75 mm in diameter, in the right lobe.
    Contrast-enhanced ultrasonography using Sonazoid indicated irregular hyper-enhancement in the vascular phase and hypoecho in the Kupffer phase. We diagnosed a metastatic liver tumor or cholangiocellular carcinoma and performed a right hepatectomy. Microscopic examination revealed that the tumor consisted of uniform and spindle cells with a fascicular growth pattern. Immunohistochemically, c-kit and CD34 were expressed. The tumor was diagnosed as a metastasis of the GIST, the gastric submucosal tumor resected 12 years ago.
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  • An autopsy case of intrahepatic cholangiocarcinoma associated with neurofibromatosis type 1 (von Recklinghausen's disease)
    Toshimasa Koyanagi, Akihide Masumoto, Hirotaka Tajiri, Masayoshi Yada, ...
    Article type: Case Report
    2012 Volume 53 Issue 4 Pages 231-236
    Published: 2012
    Released on J-STAGE: April 27, 2012
    DOIhttps://doi.org/10.2957/kanzo.53.231
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    A 69-year old man, who had neurofibromatosis type 1 (von Recklinghausen's disease), was referred to our hospital because of a symptom of persistent abdominal fullness. The extensive examinations revealed huge hepatic mass in the left lobe, suggesting a diagnosis of intrahepatic cholangiocarcinoma. One month later, the patient showed a rapid progress of anemia and bloody ascites suggestive of tumor rupture. Hepatic anteriography showed a large heterogeneous tumor in the left lateral lobe and transcathetel arterial embolization was performed. However, the patient died from hepato-renal failure. An autopsy revealed moderately-differentiated intrahepatic cholangiocarcinoma with necrosis and vascular invasion, metastasizing to the lungs, hilar lymph nodes, parietal pleura, right kidney, perisplenic fat, and adrenal glands. Intrahepatic cholangiocarcinoma associated with neurofibromatosis type 1 is rare.
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