Case Reports in Hepatology最新文献

{"title":"The Abscess That Was Cancer: Pyogenic Liver Abscess as the Initial Manifestation of Hepatocellular Carcinoma in a Noncirrhotic Patient.","authors":"Francesco Siviero, Muhammad Ali Muslimani, Sonia Lerta, Sofia Frattola, Pietro Valsecchi, Raffaella Lissandrin, Laura Maiocchi, Marcello Maestri, Alessandro Vanoli, Angela Maria Di Matteo, Raffaele Bruno, Enrico Brunetti","doi":"10.1155/crhe/9286315","DOIUrl":"10.1155/crhe/9286315","url":null,"abstract":"<p><strong>Background: </strong>Malignant and benign hepatic diseases may both present with systemic symptoms and necrotic liver cavities. Although rare and reported predominantly in East Asia, pyogenic liver abscess (PLA) can represent the initial manifestation of hepatocellular carcinoma (HCC), as necrotic tumors may mimic infectious abscesses.</p><p><strong>Case presentation: </strong>A 63-year-old Italian man presented with a 2-week history of fever and right upper quadrant pain. Computed tomography revealed a multiloculated lesion with irregular margins and a solid component in the right hepatic lobe, suggestive of a liver abscess, and empirical tigecycline therapy was initiated. Low-titer <i>Entamoeba</i> spp. IgG antibodies were detected, and percutaneous aspiration yielded material initially mischaracterized as \"anchovy paste,\" raising suspicion for amoebic liver abscess. However, the patient failed to improve despite appropriate antiprotozoal therapy. Subsequent percutaneous drainage led to cavity resolution and symptom relief; all microbiological and parasitological tests were negative, and repeat <i>Entamoeba</i> serology became negative. Concurrent biopsy of the solid component revealed well-differentiated pseudoglandular HCC. Magnetic resonance imaging demonstrated a biliary fistula associated with the neoplastic lesion, supporting a diagnosis of PLA secondary to HCC. The patient underwent right hepatectomy, complicated by intraoperative abscess rupture and postoperative intra-abdominal abscesses caused by vancomycin-resistant <i>Enterococcus faecium</i>.</p><p><strong>Discussion: </strong>PLA presenting as the initial manifestation of HCC is associated with poor prognosis, largely due to diagnostic delays. Limited clinical experience outside high-prevalence regions and nonspecific clinical, laboratory, and imaging findings contribute to underrecognition of malignancy. Positive microbiological or serological results and transient clinical improvement during antimicrobial therapy do not exclude an underlying neoplasm. Liver biopsy and close radiologic follow-up are essential in atypical or treatment-refractory cases.</p><p><strong>Conclusion: </strong>PLA as a presenting feature of HCC is unusual, especially in Europe, yet poses substantial diagnostic and therapeutic challenges. Increased clinical awareness and early histopathological evaluation are crucial to avoid delayed oncologic diagnosis.</p>","PeriodicalId":30295,"journal":{"name":"Case Reports in Hepatology","volume":"2026 ","pages":"9286315"},"PeriodicalIF":0.0,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13525368/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857834","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":"Limitations of MELD in Isolated Polycystic Liver Disease: Fatal Traumatic Cyst Rupture Complicated by Abdominal Compartment Syndrome.","authors":"Zachary C Vinton, Carter A Schulz, Stephanie J Melquist, Clark C Kulig","doi":"10.1155/crhe/5849774","DOIUrl":"https://doi.org/10.1155/crhe/5849774","url":null,"abstract":"<p><p>Isolated polycystic liver disease (PLD) is rare and may cause debilitating mass-effect symptoms despite relatively preserved hepatic synthetic function. Because the Model for End-Stage Liver Disease (MELD) score does not capture nutritional, functional, and mechanical disease burden, affected patients may have low calculated MELD scores despite advanced symptomatic disease. Updated MELD exception guidance broadened consideration for PLD to include malnutrition and sarcopenia. We describe a patient with isolated PLD who was initially considered too well for transplantation but subsequently developed progressive weight loss, sarcopenia, and functional decline, prompting repeat evaluation, wait-list registration, and MELD exception approval. Several weeks after listing, he sustained traumatic hepatic cyst rupture, resulting in fatal hemoperitoneum and abdominal compartment syndrome. This case highlights the evolving clinical course of symptomatic PLD, the importance of longitudinal reassessment, and the potential severity of rare cyst-related complications.</p>","PeriodicalId":30295,"journal":{"name":"Case Reports in Hepatology","volume":"2026 ","pages":"5849774"},"PeriodicalIF":0.0,"publicationDate":"2026-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13478724/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148798760","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":"Ashwagandha-Induced Herb-Induced Liver Injury Assessed With the Updated 2016 RUCAM.","authors":"Samuel Pérez Pérez, Erika Zumaqué-Valverde, María Fernanda Saavedra Chacón, Ariel Antonio Arteta Cueto","doi":"10.1155/crhe/8417352","DOIUrl":"10.1155/crhe/8417352","url":null,"abstract":"<p><p>Ashwagandha-induced herb-induced liver injury (HILI) has increasingly been reported; however, many published cases show methodological variability in causality assessment and limited clinicopathological correlation. We present a case of ashwagandha-associated liver injury with systematic causality evaluation using the updated 2016 Roussel Uclaf Causality Assessment Method (RUCAM) and comprehensive clinicopathological correlation. A previously healthy 27-year-old woman developed jaundice and generalized pruritus after consuming ashwagandha for three days. Infectious, autoimmune, and metabolic etiologies were excluded. Abdominal magnetic resonance imaging showed no structural abnormalities, while liver biopsy demonstrated a classic cholestatic pattern without fibrosis. Causality assessment using the updated 2016 RUCAM yielded a score of 7 points, consistent with probable HILI. The patient received symptomatic management, corticosteroids, and azathioprine, with progressive clinical and biochemical improvement. This case highlights the value of a systematic causality approach using updated RUCAM criteria together with complete clinicopathological correlation to strengthen diagnostic confidence in suspected HILI associated with herbal supplements.</p>","PeriodicalId":30295,"journal":{"name":"Case Reports in Hepatology","volume":"2026 ","pages":"8417352"},"PeriodicalIF":0.0,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13417485/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148621347","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":"Liver Injury Associated With Irregular Herbal Products: A Translational Case Series With Chemical Authentication and Causality Assessment Using the Updated RUCAM.","authors":"Ferdinando Lucas Góis, Rebeca Santos do Amaral de Souza, Raymundo Paraná, Vinícius Nunes, Genario Oliveira Santos Júnior, Ademir Evangelista do Vale","doi":"10.1155/crhe/5905774","DOIUrl":"10.1155/crhe/5905774","url":null,"abstract":"<p><strong>Background: </strong>Herb-induced liver injury (HILI) represents an increasing diagnostic challenge owing to the widespread use of herbal and dietary supplements (HDS), which are frequently consumed without reliable information regarding their composition or safety. Mischaracterized products may obscure causal attributes and mimic primary herbal hepatotoxicity.</p><p><strong>Methods and results: </strong>We report a case series of five patients with suspected HILI at a tertiary university hospital in Bahia, Brazil. Clinical causality was prospectively assessed using the updated Roussel Uclaf Causality Assessment Method (RUCAM, 2016). Most patients present with hepatocellular injury following exposure to commercially available HDS, frequently in the presence of metabolic comorbidities. Analytical authentication of the consumed products revealed substantial label-composition discordance, including negligible amounts of turmeric-derived constituents in a <i>Curcuma longa</i> formulation and multiple undeclared synthetic drugs in a weight-loss product. The integration of structured clinical assessment with product verification refined causal attribution and, in selected cases, supported the reclassification of suspected herbal hepatotoxicity as probable adulteration-related drug-induced liver injury.</p><p><strong>Conclusion: </strong>Product authentication may substantially improve the diagnostic accuracy of suspected HILI and reduce the etiological uncertainty. Incorporating the verification of consumed supplements into hepatology evaluation may help distinguish true herbal hepatotoxicity from adulteration-related liver injury, thereby improving patient safety and pharmacovigilance.</p>","PeriodicalId":30295,"journal":{"name":"Case Reports in Hepatology","volume":"2026 ","pages":"5905774"},"PeriodicalIF":0.0,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13377616/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148580353","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":"Amoxicillin-Induced Drug-Induced Liver Injury Superimposed on Acute Hepatitis C Infection in a Patient With Hurler Syndrome: A Diagnostic Challenge Assessed by the Updated RUCAM.","authors":"Archit Garg, Prosper Seshie, Abhishek Chouthai, Sahil Raval, Aadhithyaraman Santharaman, Adil Manzoor, Arkady Broder","doi":"10.1155/crhe/5815563","DOIUrl":"10.1155/crhe/5815563","url":null,"abstract":"<p><strong>Background: </strong>Drug-induced liver injury (DILI) refers to hepatotoxicity caused by conventional chemical drugs or xenobiotics, whereas herb-induced liver injury (HILI) is attributed to herbal and dietary supplements. Both these conditions pose diagnostic challenges, particularly when concurrent etiologies such as acute viral hepatitis are present. Hurler syndrome (mucopolysaccharidosis Type I) causes hepatocyte and Kupffer cell vacuolization and can predispose to DILI. Early diagnosis is critical given the high fatality rates associated with DILI.</p><p><strong>Case report: </strong>We present a case of a 28-year-old male with Hurler syndrome who presented with acute onset of nausea, vomiting, and jaundice. Liver function tests (LFTs) revealed markedly elevated liver enzymes. Serological workup identified newly acquired acute hepatitis C virus (HCV) infection. The patient had recent amoxicillin use and was taking hibiscus tea daily. Causality assessment using the updated Roussel Uclaf Causality Assessment Method (RUCAM) of 2016 yielded a score of 6 (probable DILI). Liver biopsy confirmed DILI. The patient showed clinical improvement with N-acetylcysteine and corticosteroids, with progressive normalization of liver enzymes.</p><p><strong>Conclusions: </strong>This case highlights the importance of differentiating DILI from acute viral hepatitis: strong clinical suspicion, temporal relation with offending drug, liver biopsy, and treatment response assessment. Clinicians should have a high index of suspicion for DILI even in the presence of concurrent acute HCV infection, especially in patients with underlying hepatic dysfunction such as Hurler syndrome in our case.</p>","PeriodicalId":30295,"journal":{"name":"Case Reports in Hepatology","volume":"2026 ","pages":"5815563"},"PeriodicalIF":0.0,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13269169/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148273194","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":"Fulminant Hepatic Failure Following Initiation of Abiraterone in Metastatic Prostate Cancer: A Fatal Adverse Drug Reaction.","authors":"Emma Tilma, Esben Bolvig Mark, Asbjørn Mohr Drewes","doi":"10.1155/crhe/8134585","DOIUrl":"10.1155/crhe/8134585","url":null,"abstract":"<p><strong>Background: </strong>Abiraterone acetate is widely used in metastatic castration-resistant prostate cancer and is generally considered safe. Hepatotoxicity is a known adverse effect, but fulminant liver failure remains a rare and potentially fatal complication.</p><p><strong>Case presentation: </strong>An 80-year-old man with metastatic prostate cancer was admitted with high-grade fever and general deterioration three weeks after initiation of abiraterone in addition to ongoing androgen deprivation therapy. He presented with jaundice, hypotension, and altered mental status. Laboratory investigations revealed severe acute liver injury with markedly elevated transaminases, coagulopathy, hyperbilirubinemia, acute kidney injury, metabolic acidosis, and hypoglycemia. Computed tomography demonstrated marked periportal hepatic edema and mild hilar lymphadenopathy, consistent with severe acute liver injury. No focal hepatic lesions or malignancy were identified. Despite discontinuation of abiraterone and supportive care, there was a progression to multiorgan failure, and the patient died within 48 h of admission. Postmortem investigations excluded acute hepatitis A and cytomegalovirus infection. Epstein-Barr virus serology was consistent with past infection, excluding acute infection. Although histological confirmation was not obtained, the clinical course and temporal association were highly suggestive of drug-induced liver injury.</p><p><strong>Conclusion: </strong>This case highlights a rare but catastrophic adverse reaction to abiraterone. Regular monitoring of liver function and early consideration of hepatotoxicity in patients presenting with systemic symptoms during treatment are essential.</p>","PeriodicalId":30295,"journal":{"name":"Case Reports in Hepatology","volume":"2026 ","pages":"8134585"},"PeriodicalIF":0.0,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13254483/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148253640","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":"Desmoid Tumor of the Porta Hepatis: A Rare Location With Unusual Clinical Presentation.","authors":"Adila Adilli, Altay Aliyev, Yıldırım Karslıoğlu, Gulen Bulbul Dogusoy, Eldar Ahmadov, Parvana Asgarova, Farida Agayarlı, Iqbal Babazade, Arturan Ibrahimli, Gunel Ziyadova","doi":"10.1155/crhe/1253334","DOIUrl":"10.1155/crhe/1253334","url":null,"abstract":"<p><strong>Background: </strong>Desmoid tumor is a locally aggressive fibroblastic/myofibroblastic neoplasm frequently arising in deep soft tissues. Although it can be well circumscribed, a desmoid tumor generally infiltrates surrounding tissues and tends to recur locally without metastasizing. While commonly arising in the extremities and abdominal wall, primary hepatic involvement is exceedingly uncommon.</p><p><strong>Case report: </strong>We report the case of a 20-year-old woman presenting with progressive jaundice, pruritus, weight loss, and abdominal pain. Imaging revealed a 3 × 3 cm hepatic hilar mass with bile duct dilation, initially suggestive of cholangiocarcinoma. Histopathological examination following a tru-cut biopsy demonstrated features consistent with desmoid-type fibromatosis, confirmed by nuclear β-catenin positivity. Due to clinical deterioration, the patient underwent a left hemihepatectomy. The postoperative course was uneventful. Adjuvant tamoxifen therapy was administered, and follow-up imaging showed no recurrence. Despite the hormonal changes of a subsequent pregnancy, no disease progression was observed.</p><p><strong>Conclusion: </strong>This report highlights an extremely rare presentation of desmoid tumor in the hepatic hilum, mimicking malignancy. It underscores the importance of histopathological confirmation, multidisciplinary management, and individualized follow-up strategies, especially in women of reproductive age.</p>","PeriodicalId":30295,"journal":{"name":"Case Reports in Hepatology","volume":"2026 ","pages":"1253334"},"PeriodicalIF":0.0,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13162224/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147933988","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":"Prolonged Terlipressin Therapy as a Bridge to Curative TIPS for HRS-AKI in a Nontransplant Candidate.","authors":"Deirdre Reidy, Arun Jesudian, David Salerno, Catherine Lucero","doi":"10.1155/crhe/5364905","DOIUrl":"10.1155/crhe/5364905","url":null,"abstract":"<p><p>Hepatorenal syndrome-acute kidney injury (HRS-AKI) is a severe complication of advanced cirrhosis with high mortality and limited treatment options. Terlipressin is currently the only FDA-approved therapy for HRS, though recurrence is common upon discontinuation in patients without access to liver transplantation. Transjugular intrahepatic portosystemic shunt (TIPS) may provide definitive treatment for HRS-AKI in nontransplant candidates or in the setting of prolonged waitlists. This case illustrates the safety and success of terlipressin prior to TIPS for definitive treatment of HRS-AKI in a nontransplant candidate.</p>","PeriodicalId":30295,"journal":{"name":"Case Reports in Hepatology","volume":"2026 ","pages":"5364905"},"PeriodicalIF":0.0,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12947108/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147327268","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":"Improvement in Irretractable Pruritus With Intrahepatic Portosystemic Shunt Embolization: From MAID to a New Lease on Life.","authors":"Amitesh Bagha, Ali Helmi, Arash Jaberi, Gideon Hirschfield, Kristel Leung","doi":"10.1155/crhe/5822560","DOIUrl":"10.1155/crhe/5822560","url":null,"abstract":"<p><p>Pruritus is a common, often debilitating symptom of liver disease. While most commonly seen in the setting of cholestasis and biliary obstruction, intrahepatic portosystemic shunts (PSSs) may also present with pruritus. The pathophysiology of intractable pruritus is not well understood and often requires multimodal management. We present a rare case of an 81-year-old woman with severe medically refractory pruritus with elevated serum bile acids in the absence of chronic liver disease. Antipruritics and plasmapheresis produced minimal relief, leading her to contemplate medical assistance in dying (MAID). Imaging during workup revealed two intrahepatic shunts, anomalously connecting the right portal and hepatic veins. Endovascular shunt embolization led to normalization of her serum bile acids and produced remarkable symptomatic relief. This highlights a rare but treatable cause of pruritus in an adult without chronic liver disease or biliary obstruction, while showcasing embolization as a safe and effective treatment strategy with significant improvement of the patient's quality of life.</p>","PeriodicalId":30295,"journal":{"name":"Case Reports in Hepatology","volume":"2026 ","pages":"5822560"},"PeriodicalIF":0.0,"publicationDate":"2026-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12914330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146228863","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":"Transient Unexplained Severe Acute Hyperbilirubinaemia and Cholestasis in a Patient With Hereditary Spherocytosis.","authors":"Jennifer Richardson, Michael Johnston, Alison Sefcick, Karin Oien","doi":"10.1155/crhe/9398845","DOIUrl":"10.1155/crhe/9398845","url":null,"abstract":"<p><p>Hereditary spherocytosis is an inherited red cell membrane disorder resulting in haemolytic anaemia. Recognised clinical manifestations include anaemia, jaundice, splenomegaly and gallstones. Here we describe the case of a 40-year-old male with hereditary spherocytosis presenting with severe hyperbilirubinaemia. Liver biopsy demonstrated features consistent with acute severe cholestasis. Despite extensive investigations for gallstone disease and other causes of liver pathology, no aetiology was identified. There are very few reports in the literature describing cases of profound unexplained jaundice in hereditary spherocytosis. Hereditary spherocytosis may be associated with idiopathic acute cholestasis. We report that the case was managed conservatively and spontaneously resolved.</p>","PeriodicalId":30295,"journal":{"name":"Case Reports in Hepatology","volume":"2026 ","pages":"9398845"},"PeriodicalIF":0.0,"publicationDate":"2026-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12905000/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146202889","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}