Kanzo

Original Article

Pegylated interferon and ribavirin combination therapy for chronic hepatitis C associated with thyroid dysfunction

Miki Okano, Chiaki Okuse, Hiroshi Yotsuyanagi, Junko Shima, Nobuhiro H ...

2013 Volume 54 Issue 11 Pages 731-740
Published: November 20, 2013
Released on J-STAGE: December 16, 2013

DOIhttps://doi.org/10.2957/kanzo.54.731

JOURNAL FREE ACCESS

Show abstractHide abstract

Detail of pegylated interferon and ribavirin combination therapy (combination therapy) for 12 patients with chronic hepatitis C associated with thyroid dysfunction (TD) was investigated. All patients were diagnosed as having TD at the start of combination therapy according to measurements of free thyroxine, free tri iodothyronine, and thyroid stimulating hormone. The 12 patients were diagnosed as follows; 4 as subclinical-hypothyroidism, 4 as overt-hypothyroidism, and 4 as subclinical-hyperthyroidism. Two anti-thyroid peroxidase antibodies (TPO Ab)-positive patients with overt-hypothyroidism undertook thyroid hormone replacement after the start of combination therapy, of whom subsequent thyroid function stabilized and combination therapy could be continued. On the other hand, thyroid function in 5 TPO Ab-negative patients was normalized after the start of combination therapy. In this study, no patient was discontinued the combination therapy for the reason of exacerbation of TD.

View full abstract

Download PDF (344K)

Case Reports

A case of hemosiderin deposition associated with hepatic graft-versus-host disease after peripheral blood stem cell transplantation for acute lymphocytic leukemia

Wataru Jomen, Hiroyuki Kuroda, Yohei Arihara, Michiko Yamada, Tasuku H ...

2013 Volume 54 Issue 11 Pages 741-747
Published: November 20, 2013
Released on J-STAGE: December 16, 2013

DOIhttps://doi.org/10.2957/kanzo.54.741

JOURNAL FREE ACCESS

Show abstractHide abstract

A 57-year-old woman was diagnosed with acute lymphocytic leukemia (ALL) in July 2009. After complete remission, she received allogenic peripheral blood stem cell transplantation (allo-PBSCT). She had had hepatic dysfunction and high serum ferritin level since February 2011. The hepatic dysfunction had continued even after administration of ursodeoxycholic acid and bezafibrate. The findings of liver biopsy suggested Graft-versus-Host Disease (GVHD) associated with hemosiderin deposition and also 8-OHdG was strongly stained on the nuclei of hepatocytes and bile duct epithelium. The hepatic dysfunction and serum ferritin level normalized after administration of cyclosporine (CsA). The second liver biopsy showed the significant improvement of the findings of GVHD and hemosiderin deposition. These findings might suggest that hemosiderin deposition was associated with hepatic GVHD.

View full abstract

Download PDF (972K)
A fatal case of acute liver failure with hepatitis B virus genotype D infection

Tsuguru Hayashi, Hiroka Yamago, Akiko Shiraishi, Atsushi Hiraoka, Jun ...

2013 Volume 54 Issue 11 Pages 748-754
Published: November 20, 2013
Released on J-STAGE: December 16, 2013

DOIhttps://doi.org/10.2957/kanzo.54.748

JOURNAL FREE ACCESS

Show abstractHide abstract

A 85-year-old man, who had been treated with methotrexate and steroid against rheumatoid arthritis, admitted to our hospital located in north-west Shikoku, Japan, due to severe liver dysfunction. He was diagnosed with acute liver failure. He was infected with hepatitis B virus (HBV) genotype D. Though intense treatments were performed, he died with liver failure 2 weeks after the admission. The autopsy on him revealed the fibrosis of the liver and acute hepatitis. The etiology of fibrosis is obscure but history of alcohol intake, diabetes mellitus, or methotrexate might have some etiological relation. Acute hepatitis was supposed to be due to infection or reactivation of HBV genotype D. This is the first report of a fatal case of acute liver failure with HBV genotype D infection in Japan.

View full abstract

Download PDF (878K)
A case of reactive lymphoid hyperplasia of liver mimicking hepatocellular carcinoma: A case report

Kenta Yamamoto, Takashi Kumada, Seiki Kiriyama, Makoto Tanikawa, Yasuh ...

2013 Volume 54 Issue 11 Pages 755-764
Published: November 20, 2013
Released on J-STAGE: December 16, 2013

DOIhttps://doi.org/10.2957/kanzo.54.755

JOURNAL FREE ACCESS

Show abstractHide abstract

We describe a case of hepatic reactive lymphoid hyperplasia (RLH) which developed in a 71-years old Japanese woman. At first she admitted to our hospital because of the esophageal varices rupture. After her treatment, she was found to have a nodule in the liver. Her hepatitis viral-associated antigen/antibody was negative and liver function tests and tumor markers were all within normal limits without her platelet count which was 24,000/μl. Gadolinium ethoxybenzyl-diethylenetriamine-enhanced magnetic resonance imaging (MRI) and Sonazoid-enhanced ultrasonography were suggestive of hepatocellular carcinoma (HCC). CT angiography showed classical HCC enhancement pattern that tumor had increased perfusion at computed tomography during hepatic arteriography (CTHA) and a perfusion defect at computed tomography during arterial portography (CTAP). But the tumor did not have the clearly corona enhancement. We diagnosed atypical HCC. The patient was subjected tolaparoscopic partial resection of the 6th segment of the liver and the final histological report showed idiopathic portal hypertension and RLH. She was discharged without complications. RLH is a rare benign lesion in the liver. This case is very difficult to get the preoperative diagnosis. But we have to collect the more information about RLH to avoid unnecessary surgery.

View full abstract

Download PDF (979K)
A case of severe alcoholic hepatitis successfully treated by multidisciplinary treatment, including leukocytapheresis

Xinghua Ma, Atsushi Naganuma, Hiroko Sato, Daisuke Kaburagi, Riki Arai ...

2013 Volume 54 Issue 11 Pages 765-773
Published: November 20, 2013
Released on J-STAGE: December 16, 2013

DOIhttps://doi.org/10.2957/kanzo.54.765

JOURNAL FREE ACCESS

Show abstractHide abstract

A 33-year-old man was admitted to our hospital suffering from abdominal fullness, jaundice and appetite loss in August 200X+1. He had been a habitual alcohol drinker since he was 20 years old, and alcohol consumption had increased from July 200X. High fever continued and the origin remained unclear, but treatment with antibiotics was ineffective. We diagnosed the illness as systemic inflammatory response syndrome (SIRS), attributed to alcoholic hepatitis following increased alcohol abuse on compensated alcoholic liver disease. Leukocytapheresis and neutrophil-elastase inhibitor therapy were performed to improve leukocytosis. Methylprednisolone pulse therapy was also performed to control inflammation of the liver. Multidisciplinary treatment resulted in dramatic improvements to clinical symptoms. This case was instructive for understanding methods of medical treatment for severe alcoholic hepatitis.

View full abstract

Download PDF (564K)
A case of percutaneous transhepatic obliteration for hepatic encephalopathy due to portosystemic shunt after living donor liver transplantation

Hiroyuki Abe, Toru Ishikawa, Aiko Nagashima, Kanae Hirose, Tomoyuki Ku ...

2013 Volume 54 Issue 11 Pages 774-779
Published: November 20, 2013
Released on J-STAGE: December 16, 2013

DOIhttps://doi.org/10.2957/kanzo.54.774

JOURNAL FREE ACCESS

Show abstractHide abstract

The patient was a woman 30-years of age. She was performed a living donor liver transplantation across the ABO blood type barrier for alcoholic liver cirrhosis in 2005. But she had drunk after the liver transplantation. Cirrhosis progressed to chronic hepatitis due to alcohol sustained gradually, in and out of the hospital with hepatic encephalopathy due to cirrhosis and portosystemic shunt. She was admitted to our hospital and treated by percutaneous transhepatic obliteration (PTO) to occlude portosystemic shunt. After PTO, her blood ammonia decreased. She didn't have severe hepatic encephalopathy. We herein report the rare case underwent a PTO for therapeutic purposes hepatic encephalopathy after liver transplantation.

View full abstract

Download PDF (591K)
Acute onset autoimmune hepatitis in pregnancy complicated with fetal ascites: A case report

Takashi Fushimi, Hironori Koga, Yutaka Kozuma, Teruko Arinaga-Hino, Ta ...

2013 Volume 54 Issue 11 Pages 780-786
Published: November 20, 2013
Released on J-STAGE: December 16, 2013

DOIhttps://doi.org/10.2957/kanzo.54.780

JOURNAL FREE ACCESS

Show abstractHide abstract

A 31-year old pregnant female complained skin itching and sleep disturbance at 14 weeks of her second pregnancy. At 20 weeks of the pregnancy, jaundice was noted and she was admitted to our hospital. Despite of intensive examination, including assays for viral infections and auto-antibodies such as anti-nuclear antibody, etiology of the jaundice-causing hepatitis was not determined. Since hepatoprotective therapies did not improve her liver function or fetal ascites diagnosed by ultrasonography, termination of pregnancy was performed at her and her family's desire at 21 weeks and 6 days of her pregnancy. Immediately after the termination, her liver function turned to be improved. Two weeks after the termination, however, serum levels of transaminases were sharply re-elevated (i.e., 367 IU/mL in ALT). Based on the histological diagnosis for AIH, predonisolone therapy (40 mg/body) was started, showing favorable response to ameliorate her liver function immediately. Although trigger for both maternal AIH and fetal ascites was unclear, breakdown of maternal-fetal immune tolerance might be involved.

View full abstract

Download PDF (586K)
A case of amoebic liver abscess that developed during triple therapy for chronic hepatitis C

Kazufumi Dohmen, Hirofumi Tanaka, Masatora Haruno, Hiroshi Otoba, Shin ...

2013 Volume 54 Issue 11 Pages 787-795
Published: November 20, 2013
Released on J-STAGE: December 16, 2013

DOIhttps://doi.org/10.2957/kanzo.54.787

JOURNAL FREE ACCESS

Show abstractHide abstract

Triple therapy comprising telaprevir, pegylated interferon (PegIFN) and ribavirin was administered to a 58-year-old male with a high viral load of chronic serotype 1 hepatitis C. One month after the treatment, HCVRNA was undetected in the serum. However, four months after the start of administration, he developed a fever, loss of appetite and right hypochondrial pain. A laboratory examination revealed an elevated white blood cell count of 9,100 /μl and an increased concentration of C-reactive protein of 15.17 mg/dl. Ultrasonography and a computed tomography scan revealed hypoechoic and low density space-occupying lesions (SOLs) in the liver. The triple therapy was discontinued, and was replaced by antibiotics. However, the fever persisted and the SOLs in the liver became enlarged, part of which ruptured into the peritoneal cavity. Anti-amoebic antibodies were detected, and aspirated fluid of high viscosity was found to be creamy with a whitish and light yellow-greenish color, from which large number of Entamoeba histolytica trophozoites were isolated. Therefore, a diagnosis of amoebic liver abscesses was confirmed. The administration of metronidazole and catheter drainage were performed promptly. The fever disappeared and the SOLs in the liver diminished. Based on a repeat interview, a colonoscopy was performed, and the patient was confirmed to have developed aphthoid colitis five months before the administration of triple therapy. The aphthoid colitis was likely to be due to Entamoeba histolytica. Clinicians should be aware that an amoebic liver abscess can develop as an adverse effect during triple therapy for chronic hepatitis C, and a rapid diagnosis and attentive interviews were important in the present case to ensure that the patient's condition did not deteriorate.

View full abstract

Download PDF (816K)

Rapid Communication

Serum free fatty acid concentration as a surrogate marker for serum carnitine status in patients with liver cirrhosis

Kazuyuki Suzuki, Mio Onodera, Keisuke Kakisaka, Kei Endo, Kei Sawara, ...

2013 Volume 54 Issue 11 Pages 796-797
Published: November 20, 2013
Released on J-STAGE: December 16, 2013

DOIhttps://doi.org/10.2957/kanzo.54.796

JOURNAL FREE ACCESS

Show abstractHide abstract

Aim: Carnitine (CA) is essential for β-oxidation of long-chain fatty acid in mitochondrial matrix in the muscle, liver and kidney. Although liver cirrhosis (LC) may present secondary CA deficiency caused by disturbed biosynthesis in the liver, inadequate food intake and muscle atrophy. Although renal dysfunction has been known to be associated with the CA dynamics, the CA status in the blood in LC patients has not been fully studied, at least in part, because expensive cost of CA measurement. Therefore, we tried to find an alternative parameter reflecting the serum CA status in patients with LC. Subjects and methods: Sixty-two patients with LC (male 41, female 21, age between 35 and 80, etiologies; HBV 5, HCV 26, HCV+Alcohol 2, Alcohol 18, nonBnonC 5, NASH 3, PBC 1, AIH 1, cryptogenic 1) were evaluated the CA status in the blood. Serum CA [total CA (T-CA), free-CA (F-CA) and acyl-CA (Ac-CA)] levels were determined using the enzymatic cycling method (KAINOS Laboratories Inc., Tokyo, Japan). Liver function tests including prothrombin time, ammonia, urea nitrogen, creatinine and free fatty acid (FAA) were measured simultaneously. Results: Serum T-CA, F-CA and Ac-CA levels showed no correlations with the parameters of liver function test except serum creatinine. In contrast, serum FFA levels showed positive correlations with Ac-CA level and with the Ac-CA/T-CA ratio. Conclusion: The serum FAA levels may be potentially useful as a parameter reflecting abnormal status of serum CA in patients with LC.

View full abstract

Download PDF (203K)

Register with J-STAGE for free!