Case Reports in Hepatology最新文献

{"title":"A Rare, Atypical Presentation of Decompensated Cirrhosis: Isolated Transudative Hepatic Chylothorax Without Ascites.","authors":"Michael Yulong Wu, Rhian Aghajani, Sophie Timmins, Anna Di Bartolomeo, Rachael Jacob, Robert Ng, Jacob George, Harry Crane, Cameron Gofton","doi":"10.1155/crhe/5596329","DOIUrl":"10.1155/crhe/5596329","url":null,"abstract":"<p><p>Hepatic hydrothorax is an uncommon presentation of decompensated liver cirrhosis and usually presents after other complications of portal hypertension such as ascites. We report the case of a 73-year-old female with autoimmune hepatitis (AIH) treated with budesonide, presenting with a right-sided hepatic chylothorax secondary to AIH and subsequent diagnosis of primary biliary cholangitis (PBC). Pleural fluid analysis revealed a transudative chylothorax, whilst serology, liver elastography, hepatic venous pressure gradients and biopsy diagnosed advanced fibrosis with portal hypertension secondary to AIH-PBC overlap syndrome. Commencement of diuretics led to the resolution of the recurrent pleural effusion. Chylothorax is typically an exudative effusion; however, in very rare cases of decompensated liver cirrhosis, it may present as an isolated transudative effusion in the absence of other signs of portal hypertensive complications such as ascites. This is the first reported case of decompensated cirrhosis secondary to AIH-PBC overlap syndrome, presenting as an isolated unilateral transudative chylothorax.</p>","PeriodicalId":30295,"journal":{"name":"Case Reports in Hepatology","volume":"2025 ","pages":"5596329"},"PeriodicalIF":0.0,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12517972/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145293952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hepatic Endometriosis Misdiagnosed as Hepatic Epithelioid Hemangioendothelioma.","authors":"Aditya Kler, Nirjhar Dutta, Jennifer Haglund","doi":"10.1155/crhe/3676537","DOIUrl":"10.1155/crhe/3676537","url":null,"abstract":"<p><p>We describe the case of a young 42-year-old female who suffered from cyclical right upper quadrant abdominal pain that led to an emergency department visit where an intrahepatic mass was found on imaging. Initial CT-guided biopsy led to the diagnosis of hepatic epithelioid hemangioendothelioma, and the patient was referred to a liver transplant center. She underwent hepatic segmentectomy with right nephrectomy and surgical pathology came to the correct diagnosis of hepatic endometriosis.</p>","PeriodicalId":30295,"journal":{"name":"Case Reports in Hepatology","volume":"2025 ","pages":"3676537"},"PeriodicalIF":0.0,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12373462/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Autoimmune-Like Hepatitis Following Hepatic Graft-Versus-Host Disease in an Allogenic Hematopoietic Cell Transplant Recipient.","authors":"Harish Gopalakrishna, David E Kleiner, Jennifer A Kanakry, Marc G Ghany","doi":"10.1155/crhe/8411674","DOIUrl":"10.1155/crhe/8411674","url":null,"abstract":"<p><p>One of the major complications following hematopoietic cell transplantation (HCT) is the occurrence of graft-versus-host disease (GVHD). The liver is a target organ in both acute and chronic GVHD. Histologically, there are two distinct forms of hepatic involvement by GVHD, namely cholestatic (classical) and hepatic. Autoimmune-like hepatitis has been reported as a late complication of HCT with some considering it to be a variant of hepatic GVHD. However, there are no reports of hepatic form of GVHD and autoimmune-like hepatitis in the same patient post-HCT. Herein, we report a patient who initially developed hepatic GVHD followed by autoimmune-like hepatitis.</p>","PeriodicalId":30295,"journal":{"name":"Case Reports in Hepatology","volume":"2025 ","pages":"8411674"},"PeriodicalIF":0.0,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12367393/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unmasking Cryoglobulinemia: A Cold-Blooded Complication of Hepatitis C.","authors":"Alexandra M Arges, Ari Levine","doi":"10.1155/crhe/8382433","DOIUrl":"10.1155/crhe/8382433","url":null,"abstract":"<p><p>A 43-year-old man presents to the hospital with two weeks of persistent fevers, accompanied by myalgias, hematochezia, and abdominal pain. Acute infectious causes were ruled out, and elevated inflammatory markers suggested inflammatory diarrhea or autoimmune conditions. Esophagogastroduodenoscopy (EGD) and colonoscopy were negative. Further testing showed positive antinuclear antibodies (ANAs), ribonucleoprotein (RNP), rheumatoid factor (RF), and hepatitis C virus (HCV) RNA, suggesting an HCV-associated autoimmune process. Hematuria and neuropathic pain raised suspicion for mixed cryoglobulinemia secondary to HCV, supported by low complement levels. Treatment started with prednisone. Cryoglobulins came back positive, confirming mixed cryoglobulinemia secondary to HCV. The patient was referred to the hepatology clinic for antiviral treatment, where he completed treatment, with symptoms resolving, except for his neuropathy.</p>","PeriodicalId":30295,"journal":{"name":"Case Reports in Hepatology","volume":"2025 ","pages":"8382433"},"PeriodicalIF":0.0,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12313380/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144761599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fatal Liver Failure After Herpes-Simplex-Virus-2-Induced Acute Necrotizing Hepatitis: A Case Report.","authors":"Thomas Rösner, Julia Grenz, Marlene Schaumäker, Sven Cuntz, Norbert Blank, Alphonse Charbel, Christa Flechtenmacher, Patrick Michl, Jan Pfeiffenberger, Monica Boxberger, Isabelle Mohr","doi":"10.1155/crhe/1414531","DOIUrl":"10.1155/crhe/1414531","url":null,"abstract":"<p><p>Herpes simplex virus (HSV) infections are common in the European population, typically presenting with mucocutaneous and anogenital manifestations. However, disseminated infections and organ involvement are rare, usually occurring in immunocompromised individuals, particularly after hematopoietic stem cell or solid organ transplantation. HSV1/2-induced hepatitis is infrequent but can result in acute liver failure (ALF) and increased mortality. We present a case of fulminant ALF caused by disseminated primary HSV2 infection in a fifty-year-old male with rheumatoid arthritis treated with the JAK-inhibitor upadacitinib for 3 months prior to presentation. Clinical examination revealed severe oropharyngeal mucositis and hepatic encephalopathy. Initial laboratory results showed bicytopenia, significantly elevated transaminases, bilirubin, inflammatory markers, and severe coagulopathy. Empirical treatment with an antimicrobial regimen, intravenous aciclovir, acetylcysteine, and plasmapheresis (PPH) was initiated. The patient was listed for urgent liver transplantation based on King's College criteria. Further investigations revealed a high viral load of HSV2 DNA in the blood, and transjugular liver biopsy confirmed extensive liver necrosis with positive HSV staining. Despite antiviral therapy, the HSV2 viral load remained high, indicating resistance, and the patient was deemed \"nontransplantable\" due to clinical deterioration with progressive hepatic coma, hemorrhagic-septic shock, multiorgan failure, and secondary bowel ischemia, ultimately leading to the patient's death from refractory shock. This is only the second documented case of fulminant ALF due to HSV2 hepatitis in a patient undergoing JAK inhibition, and the first involving upadacitinib. It highlights the importance of considering primary herpesvirus infection as a potential cause of ALF, particularly in immunocompromised patients, and underscores the need for early antiviral intervention to improve outcomes.</p>","PeriodicalId":30295,"journal":{"name":"Case Reports in Hepatology","volume":"2025 ","pages":"1414531"},"PeriodicalIF":0.0,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12310311/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144754645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sarcomatoid Carcinoma Arising in the Gallbladder of a 58-Year-Old Female: Case Report.","authors":"Ahmed A Ahmed, Yan Gao, Rossana Kazemimood","doi":"10.1155/crhe/5172834","DOIUrl":"10.1155/crhe/5172834","url":null,"abstract":"<p><p>Sarcomatoid carcinoma of the gallbladder is a rare malignancy with no specific clinical manifestation. It is characterized by the presence of malignant epithelial and mesenchymal components intermingled with each other. This disease usually presents at an advanced stage, and its final diagnosis needs to be confirmed by histopathological and immunohistochemical examination. Sarcomatoid carcinoma is characterized by early metastasis through lymphatics, rapid progression, a high recurrence rate, and a worse prognosis than usual gallbladder adenocarcinoma. Herein, we report the case of a 58-year-old female patient, who underwent laparoscopic cholecystectomy, with sarcomatoid carcinoma of the gallbladder. Histologically, the epithelial component of the tumor was composed of adenocarcinoma, and the mesenchymal component was composed of spindle cell sarcoma and chondrosarcoma. The tumor was identified as invading the perimuscular connective tissue on the hepatic side without involvement of the liver. The prognosis of sarcomatoid carcinoma of the gallbladder remains poor despite surgical resection of the gallbladder. The patient passed away in less than 1 year after the procedure despite chemotherapy due to cancer progression.</p>","PeriodicalId":30295,"journal":{"name":"Case Reports in Hepatology","volume":"2025 ","pages":"5172834"},"PeriodicalIF":0.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12226207/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144576477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case Report: Partial Splenic Artery Embolization for the Treatment of Painful Splenomegaly Secondary to Noncirrhotic Portal Hypertension.","authors":"Logan Kratzer, Maddison Waters, Simon Parkes, Nicholas Cheung, Nicholas Shackel","doi":"10.1155/crhe/9303407","DOIUrl":"10.1155/crhe/9303407","url":null,"abstract":"<p><p>Noncirrhotic portal hypertension (NCPH) is a rare cause of portal hypertension with varied etiologies. We present two cases of painful splenomegaly secondary to NCPH successfully treated with partial splenic artery embolization (PSE). Despite limited literature on PSE's efficacy for NCPH-related painful splenomegaly, our cases demonstrate significant pain relief and reduction in opiate dependence postprocedure. Imaging revealed substantial decreases in spleen size without major complications. PSE emerges as a promising therapeutic option for NCPH-related painful splenomegaly, offering improved quality of life and reduced reliance on analgesics.</p>","PeriodicalId":30295,"journal":{"name":"Case Reports in Hepatology","volume":"2025 ","pages":"9303407"},"PeriodicalIF":0.0,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12165750/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recurrent Ascites Beyond the Usual Suspects: Uncovering an Overlooked Culprit.","authors":"Binoy Desai, Harjit Singh, Alessandra Martorella, Bryce Kunkle, Amol S Rangnekar","doi":"10.1155/crhe/9961539","DOIUrl":"10.1155/crhe/9961539","url":null,"abstract":"<p><p>Hepatic amyloidosis is a rare condition that leads to progressive liver dysfunction. Diagnosis is often challenging since clinical presentation may be highly varied and is dependent upon the extent of liver involvement, underlying etiology of amyloid deposition, as well as concomitant extrahepatic manifestations. Ascites, although uncommon, can be a presenting feature of hepatic amyloidosis and pose diagnostic challenges as it can occur in a variety of liver and nonliver-related conditions. Herein, we present a case of hepatic amyloidosis in a patient with recurrent ascites, emphasizing the importance of considering this condition in the differential diagnosis of individuals presenting with unexplained ascites.</p>","PeriodicalId":30295,"journal":{"name":"Case Reports in Hepatology","volume":"2025 ","pages":"9961539"},"PeriodicalIF":0.0,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12126255/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hemophagocytic Lymphohistiocytosis Complicating a Case of Drug-Induced Liver Injury Precipitated by Cephalexin: A Rare Consequence of Commonly Prescribed Medications.","authors":"Matthew T Newman, Thu Anne Mai, Joe McClanaghan, Nicholas Burley, Tamira Robinson, Yang Jiang, Amandeep Sahota","doi":"10.1155/crhe/4600879","DOIUrl":"10.1155/crhe/4600879","url":null,"abstract":"<p><p>Drug-induced liver injury (DILI) is a relatively rare clinical syndrome that accounts for a significant proportion of acute liver failure progressing to transplant in the United States. Some drugs such as acetaminophen are classically associated with a predictable pattern of DILI that can often be reversed with prompt administration of guideline-directed therapeutics. In other cases, commonly prescribed medications can lead to an unpredictable variant of DILI in certain vulnerable populations for which few guidelines on management exist, likely in part due to the heterogeneity of precipitating toxins. We report a case of idiosyncratic DILI caused by cephalexin that progressed to fulminant hemophagocytic lymphohistiocytosis (HLH) in a young and previously healthy patient, alongside our experiences with therapeutic management and outcomes guided by a multidisciplinary team.</p>","PeriodicalId":30295,"journal":{"name":"Case Reports in Hepatology","volume":"2025 ","pages":"4600879"},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12105900/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Budd-Chiari Syndrome Treated With IVC Stenting With Subsequent Right Hepatic Vein to IVC Retrograde Sharp Recanalization.","authors":"Andrew C Gordon, Kush R Desai, Justin R Boike, Bartley G Thornburg","doi":"10.1155/crhe/2216461","DOIUrl":"10.1155/crhe/2216461","url":null,"abstract":"<p><p>Venous webs of the inferior vena cava (IVC) and hepatic veins are rare and can result in Budd-Chiari syndrome. Included images of classic venous webbing are from a 60-year-old woman who presented with abdominal distension/pain, lower extremity edema, elevated liver tests, and ascites due to multifocal venous webbing of the IVC and right hepatic vein. The patient was successfully treated with IVC venous stent placement. Delayed recurrence of ascites, abdominal distention, and liver dysfunction after 3 years of follow-up was attributed to an additional right hepatic vein web/occlusion that was treated with a hepatic vein to IVC recanalization and stenting. The patient had complete resolution of symptoms at 2-year follow-up.</p>","PeriodicalId":30295,"journal":{"name":"Case Reports in Hepatology","volume":"2025 ","pages":"2216461"},"PeriodicalIF":0.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12097869/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}