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Case Reports in Hepatology

Mahmood Alawainati, Jawad Khamis, Muneer Abdulla, Saeed Alsaeed
Background: There are multiple aetiologies for dyspnea in patients with liver disease, including pneumonia, pulmonary embolism, hepatic hydrothorax, portopulmonary syndrome, and hepatopulmonary syndrome. The aim of this paper is to emphasize the importance of early diagnosis and management of hepatopulmonary syndrome. Case Presentation: We report a case of a 65-year-old male who was known to have chronic hepatitis C presented with one-year history of shortness of breath and cyanosis...
2019: Case Reports in Hepatology
Shigeru Koba, Kazuki Ueda, Masahiro Mori, Kenji Miki, Shinsaku Imashuku
Diagnosis of invasive cryptococcal infection in apparently nonimmunocompromised patients is difficult and often delayed. Human immunodeficiency virus- (HIV-) negative patients with decompensated hepatic cirrhosis might be at high risk of cryptococcal infection. We report here an 82-year-old Japanese female with end-stage hepatic failure and undergoing renal dialysis, hospitalized with septic shock-like symptoms. The patient had had hepatitis B virus (HBV) infection in the past. She survived only 4 days following admission...
2018: Case Reports in Hepatology
Oscar Suarez, María Perez, Martin Garzon, Rodrigo Daza, Geovanny Hernandez, Carolina Salinas, Jorge Ceballos, Enrique P de Leon, Jacqueline Mugnier, Oscar Beltrán, Adriana Varón
Fibrolamellar hepatocarcinoma is an infrequent liver tumor, currently considered to be a variant different from hepatocarcinoma. The differences lie in genomic alterations, a greater prevalence of fibrolamellar hepatocarcinoma in young patients, and its lack of association with underlying liver disease. The clinical presentation is unspecific, with symptoms ranging from abdominal pain, malaise, and weight loss to atypical manifestation which include hyperammonemic encephalopathy. We present the case of a 33-year-old woman with no prior medical history who presented with a coma and a diagnosis of inoperable fibrolamellar hepatocarcinoma requiring a cadaver donor transplant...
2018: Case Reports in Hepatology
Hiromi Fukuda, Kazuhide Takata, Takanori Kitaguchi, Ryo Yamauchi, Hideo Kunimoto, Takashi Tanaka, Keiji Yokoyama, Daisuke Morihara, Yasuaki Takeyama, Satoshi Shakado, Ai Mogi, Shinichi Kora, Kaori Koga, Morishige Takeshita, Kengo Yoshimitsu, Shotaro Sakisaka
Patients with autoimmune hepatitis (AIH) may sometimes have concomitant idiopathic thrombocytopenic purpura (ITP). Severe thrombocytopenia in ITP interferes with percutaneous liver biopsy for pathological diagnosis of AIH. Here, we report a case of AIH with ITP in a 63-year-old woman. The patient presented to our hospital with liver dysfunction and thrombocytopenia. For histological examination, transjugular liver biopsy (TJLB) was performed, leading to a diagnosis of AIH. Corticosteroids treatment led to an improvement in her liver enzyme levels and platelet count...
2018: Case Reports in Hepatology
Mara Waters, Adam Oxner, Sigmund Krajden, Richard Sultanian
Chewing khat leaves ( Catha edulis ) is common cultural practice in Eastern African countries. Khat has been implicated in cases of acute liver injury, sometimes leading to liver failure and requiring transplantation. We report the case of a 24-year-old gentleman presenting with symptoms of acute liver failure. Bloodwork demonstrated hepatocyte-predominant liver injury. Microbiological and serological hepatitis panels were negative, and his liver biopsy demonstrated acute cholestatic hepatitis. He admitted to regular khat use for several years prior to his presentation...
2018: Case Reports in Hepatology
Nazneen Hussain, Samuel O Igbinedion, Richie Diaz, J S Alexander, Moheb Boktor, Kurt Knowles
Liver involvement is a known feature of secondary syphilis. The prevalence of hepatitis in secondary syphilis ranges broadly from 1 to 50%. We report a case of a 37-year-old man with type 1 diabetes mellitus and sickle cell trait presenting with jaundice and acute liver cholestasis. Abdominal ultrasound revealed mild hepatic fatty infiltration. RPR and Treponema pallidum IgG results were positive with a reflex titer of 1:64. Liver biopsy revealed chronic hepatitis with normal hepatic architecture, Kupffer cell hyperplasia, hepatic cholestasis, and ductal proliferation suggestive of syphilitic hepatitis...
2018: Case Reports in Hepatology
Dan-Qing Xue, Lan Yang
Focal nodular hyperplasia (FNH) is the second most common liver cell-derived benign tumor. It is postulated that chemotherapy-induced hepatic circulatory abnormalities, like sinusoidal obstruction syndrome (SOS), could lead to the development of FNH. Cyclophosphamide was also reported to induce SOS in a synergistic effect with total body irradiation. However, none of cyclophosphamide-related FNH had ever been reported before. In this case report, we present a female patient who was treated with neoadjuvant chemotherapy of cyclophosphamide (500mg/m2 )-docetaxel (75mg/m2 )-pharmorubicin (90mg/m2 ) regimen every 3 weeks for breast cancer developed FNH after 4 courses of treatment...
2018: Case Reports in Hepatology
Hiroyuki Sugo, Yuki Sekine, Shozo Miyano, Ikuo Watanobe, Michio Machida, Kuniaki Kojima, Hironao Okubo, Ayako Ura, Kanako Ogura, Toshiharu Matsumoto
We report here an extremely rare case of hepatic sclerosing hemangioma mimicking a biliary cystadenocarcinoma. A previously healthy 39-year-old woman was referred to our hospital because of a large tumor in the liver. Abdominal computed tomography revealed early peripheral ring enhancement in the arterial phase and slight internal heterogeneous enhancement in the delayed phase. Magnetic resonance imaging revealed a tumor with low intensity in the T1-weighted image and very high intensity in the fat-saturated T2-weighted image...
2018: Case Reports in Hepatology
Patrick T Koo, Valentina Medici, James H Tabibian
The biliary anastomosis remains a common site of postoperative complications in liver transplantation (LT). Biliary complications have indeed been termed the "Achilles' heel" of LT, and while their prevention, diagnosis, and treatment have continued to evolve over the last two decades, various challenges and uncertainties persist. Here we present the case of a 33-year-old man who, 10 years after undergoing LT for idiopathic recurrent intrahepatic cholestasis, was noted to have developed pruritus and abnormalities in serum liver biochemistries during routine post-liver transplant follow-up...
2018: Case Reports in Hepatology
Elizabeth Caitlin Brewer, Leigh Hunter
Acute liver failure (ALF) can be due to numerous causes and result in fatality or necessitate liver transplantation if left untreated. Possible etiologies of ALF include ischemia, venous obstruction, medications, toxins, autoimmune hepatitis, metabolic and infectious causes including hepatitis A-E, varicella-zoster virus (VZV), cytomegalovirus (CMV), herpes simplex virus (HSV), Epstein-Barr virus (EBV), and adenovirus with VZV being the most rarely reported. Pathognomonic skin lesions facilitate diagnosis of VZV hepatitis, but definitive diagnosis is secured with liver biopsy, tissue histopathology, culture, and specific VZV polymerase chain reaction (PCR)...
2018: Case Reports in Hepatology
Nalan Okuroglu, Meltem Sertbas, Ali Ozdemir
A 73-year-old female patient with a history of type 2 DM for seven years was admitted to our out-patient clinic with a complaint of frequent hypoglycemic episodes. She was receiving basal- bolus insulin treatment. She underwent liver transplantation 20 months ago due to end stage liver disease caused by HCV infection genotype 1b. While she was still on tacrolimus for liver transplantation, she received direct acting antiviral agents including fix dose ledipasvir-sofosbuvir with ribavirin. Biochemical analysis showed fasting plasma glucose of 105 mg/dl and postprandial glucose of 200 mg/dl, glycosylated hemoglobin A1c of 4...
2018: Case Reports in Hepatology
Emily A Minor, Mackenzie S Newman, Justin T Kupec
Historically used as an anesthetic, chloroform is a halogenated hydrocarbon that is associated with central nervous system depression, arrhythmias, and hepatotoxicity. It is no longer used clinically, but accidental and intentional poisonings still occur. We report a case of chronic chloroform abuse leading to severe hepatotoxicity in a 26-year-old male graduate student. The patient presented to the emergency department with a three-day history of abdominal pain, dehydration, and scleral icterus. He drank several beers the night before the onset of symptoms, but denied taking acetaminophen, ibuprofen, or other drugs...
2018: Case Reports in Hepatology
Karen Jiang, Ahmad Najdat Bazarbashi, Sami Dahdal, Adina Voiculescu, Natalia Khalaf
Leptospirosis is a common bacterial disease in tropical regions of the world due to greater exposure to rodents and domestic animals; however, this condition can also occur in US urban areas, though it often goes unrecognized. Gastrointestinal symptoms are very commonly seen, and icteric leptospirosis is often confused for other conditions resulting in delayed diagnosis and worse outcomes. As mortality increases with more extensive hepatic involvement, gastroenterologists should be aware of the constellation of gastrointestinal symptoms related to leptospirosis, as it can occur in the absence of classic exposure history...
2018: Case Reports in Hepatology
Gregory W Charville, Sukhmani K Padda, Richard K Sibley, Ajithkumar Puthillath, Paul Y Kwo
Targeted cancer treatments offer the prospect of precise inhibition of tumor growth without the untoward off-target toxicity of traditional chemotherapies. Still, unintended, often idiosyncratic side effects, such as drug-induced liver injury, can occur. We discuss the case of a 26-year-old female with a history of ROS1 -rearranged lung adenocarcinoma, undergoing treatment with the tyrosine kinase inhibitor crizotinib, who presented to our hospital with abdominal pain and scleral icterus. Liver chemistries were notable for hyperbilirubinemia (5 mg/dL total) and marked transaminasemia (AST 1736 U/L, ALT >3500 U/L); liver biopsy demonstrated acute hepatitis with extensive necrosis...
2018: Case Reports in Hepatology
Samuel Igbinedion, Meher S Mavuram, Moheb Boktor, John Bienvenu
Liver abscesses are the most common types of visceral abscesses. Pyogenic liver abscesses, a particular type of liver abscesses, are uncommonly encountered. We present a rare case of pyogenic liver abscess caused by methicillin-susceptible Staphylococcus aureus in a young man. A 21-year- old man presented from prison to the hospital with fever, nausea, vomiting, diarrhea, and abdominal pain for five days. Labs were significant for leukocytosis with predominant neutrophilia and elevated liver enzymes. CT abdomen with contrast revealed an 8...
2018: Case Reports in Hepatology
Kazuhiro Nishida, Alan Kawarai Lefor, Tomohiro Funabiki
Introduction: Transarterial chemoembolization (TACE) is the first-line therapy for patient with unresectable hepatocellular carcinoma (HCC). Although TACE is a generally safe procedure, major complications can be occurred. We describe a patient with rupture of HCC after TACE followed by gastric bleeding. Case Presentation: An 81-year-old man presented with worsening epigastric pain. He had been diagnosed with multiple HCC with nonalcoholic steatohepatitis and underwent TACE 19 days previously...
2018: Case Reports in Hepatology
E Veitsman, E Pras, O Pappo, A Arish, R Eshkenazi, C Feray, J Calderaro, D Azoulay, Z Ben Ari
Hereditary hemochromatosis (HH) is a genetic disease associated with progressive iron overload, eventually leading in some cases to damage of parenchymal organs, such as the liver, pancreas, and heart. Although the gene had been identified (HFE), HH pathogenesis remains to be fully elucidated. We report here, for the first time, a case of inadvertent transplantation of a liver from a donor with C282Y/H63D compound heterozygosity into a nonhemochromatotic 19-year-old Caucasian male recipient with primary sclerosing cholangitis...
2018: Case Reports in Hepatology
Innocent Lule Segamwenge, Miriam Kaunanele Bernard
Objectives: To describe the clinical characteristics of patients presenting with fulminant liver failure after varying periods of exposure to Efavirenz containing antiretroviral medications. Methods: We report a series of 4 patients with human immunodeficiency virus (HIV) infection who were admitted with acute liver failure (ALF) over a 6-month period. All these patients had been treated with a range of Efavirenz containing antiretroviral regimens and were negative for hepatitis A, B, and C infections as well as other opportunistic infections, all were negative for autoimmune hepatitis, and none had evidence of chronic liver disease or use of alcohol or herbal medications...
2018: Case Reports in Hepatology
Gary A Abrams, Robert Chapman, Samuel R W Horton
We report on a rare case of refractory hepatic hydrothorax in an individual with Scleroderma/CREST syndrome and noncirrhotic portal hypertension. Portal pressure measurements revealed a normal transjugular hepatic venous portal pressure gradient, mild pulmonary hypertension, and an unremarkable liver biopsy except for mild sinusoidal dilation. Pulmonary hypertension, cardiac diastolic dysfunction, and chronic kidney disease were determined to be the causes of his refractory pleural effusions and ascites. Over the year, he underwent 50 thoracenteses and 20 paracenteses averaging 10-12 liters/week...
2018: Case Reports in Hepatology
Ifeyinwa E Obiorah, Metin Ozdemirli
Meningiomas are slow growing neoplasms of the central nervous system (CNS). Most of the tumors are benign and distant metastasis from a benign meningioma is rare. Metastasis to the liver, although rare, usually presents with hypoglycemia or occurs in conjunction with a clinical history of an intracranial meningioma or following the resection of a prior CNS meningioma, thus making clinical diagnosis relatively easy. Here we present an unusual case of metastatic meningioma to the liver in a 54-year-old female who presented with an incidental liver mass by ultrasound...
2018: Case Reports in Hepatology
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