Oscar Suarez, María Perez, Martin Garzon, Rodrigo Daza, Geovanny Hernandez, Carolina Salinas, Jorge Ceballos, Enrique P de Leon, Jacqueline Mugnier, Oscar Beltrán, Adriana Varón
{"title":"Fibrolamellar Hepatocellular Carcinoma and Noncirrhotic Hyperammonemic Encephalopathy.","authors":"Oscar Suarez, María Perez, Martin Garzon, Rodrigo Daza, Geovanny Hernandez, Carolina Salinas, Jorge Ceballos, Enrique P de Leon, Jacqueline Mugnier, Oscar Beltrán, Adriana Varón","doi":"10.1155/2018/7521986","DOIUrl":"https://doi.org/10.1155/2018/7521986","url":null,"abstract":"<p><p>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. While she was on the waiting list, she received hemofiltration and ammonium benzoate treatment, with progressive improvement in her state of consciousness.</p>","PeriodicalId":30295,"journal":{"name":"Case Reports in Hepatology","volume":"2018 ","pages":"7521986"},"PeriodicalIF":0.0,"publicationDate":"2018-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2018/7521986","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36854738","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 Hepatitis with Concomitant Idiopathic Thrombocytopenic Purpura Diagnosed by Transjugular Liver Biopsy.","authors":"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","doi":"10.1155/2018/5305691","DOIUrl":"https://doi.org/10.1155/2018/5305691","url":null,"abstract":"<p><p>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. In conclusion, patients with AIH may sometimes have concomitant ITP. TJLB was effective for making the diagnosis of AIH with severe thrombocytopenia due to ITP.</p>","PeriodicalId":30295,"journal":{"name":"Case Reports in Hepatology","volume":"2018 ","pages":"5305691"},"PeriodicalIF":0.0,"publicationDate":"2018-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2018/5305691","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36854737","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}
Mara Waters, Adam Oxner, Sigmund Krajden, Richard Sultanian
{"title":"Acute Liver Injury Associated with Khat Use in a 24-Year-Old Male.","authors":"Mara Waters, Adam Oxner, Sigmund Krajden, Richard Sultanian","doi":"10.1155/2018/2816907","DOIUrl":"https://doi.org/10.1155/2018/2816907","url":null,"abstract":"<p><p>Chewing khat leaves (<i>Catha edulis</i>) 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. His liver function tests improved with cessation of khat use. This is the first reported case of acute khat-associated hepatitis in Canada. Considering cultural practices such as khat chewing in presentations of acute liver injury are important when caring for diverse patient populations.</p>","PeriodicalId":30295,"journal":{"name":"Case Reports in Hepatology","volume":"2018 ","pages":"2816907"},"PeriodicalIF":0.0,"publicationDate":"2018-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2018/2816907","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36855714","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":"Development of Focal Nodular Hyperplasia after Cyclophosphamide-Based Chemotherapy in a Patient with Breast Cancer.","authors":"Dan-Qing Xue, Lan Yang","doi":"10.1155/2018/5409316","DOIUrl":"https://doi.org/10.1155/2018/5409316","url":null,"abstract":"<p><p>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/m<sup>2</sup>)-docetaxel (75mg/m<sup>2</sup>)-pharmorubicin (90mg/m<sup>2</sup>) regimen every 3 weeks for breast cancer developed FNH after 4 courses of treatment. The patient had no chronic liver disease, no history of smoking, drinking, or medication use. The chronological correlation between the chemotherapy and the appearance of the FNH suggested a cause-effect association. Therefore, this is the first case report about development of FNH after cyclophosphamide-based chemotherapy. Taking into account the frequency of breast cancer, it is instructive to recognize such observation of FNH in the context to make the differential diagnosis with hepatic metastasis.</p>","PeriodicalId":30295,"journal":{"name":"Case Reports in Hepatology","volume":"2018 ","pages":"5409316"},"PeriodicalIF":0.0,"publicationDate":"2018-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2018/5409316","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36662883","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}
Nazneen Hussain, Samuel O Igbinedion, Richie Diaz, J S Alexander, Moheb Boktor, Kurt Knowles
{"title":"Liver Cholestasis Secondary to Syphilis in an Immunocompetent Patient.","authors":"Nazneen Hussain, Samuel O Igbinedion, Richie Diaz, J S Alexander, Moheb Boktor, Kurt Knowles","doi":"10.1155/2018/8645068","DOIUrl":"https://doi.org/10.1155/2018/8645068","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":30295,"journal":{"name":"Case Reports in Hepatology","volume":"2018 ","pages":"8645068"},"PeriodicalIF":0.0,"publicationDate":"2018-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2018/8645068","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36662884","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 Sclerosing Hemangioma with Predominance of the Sclerosed Area Mimicking a Biliary Cystadenocarcinoma.","authors":"Hiroyuki Sugo, Yuki Sekine, Shozo Miyano, Ikuo Watanobe, Michio Machida, Kuniaki Kojima, Hironao Okubo, Ayako Ura, Kanako Ogura, Toshiharu Matsumoto","doi":"10.1155/2018/7353170","DOIUrl":"https://doi.org/10.1155/2018/7353170","url":null,"abstract":"<p><p>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. The patient underwent hepatectomy for a possible malignant liver tumor. Grossly, the tumor appeared as a white, solid, and cystic mass (weighted 1.1 kg and measured 170×100×80 mm) that was elastic, soft, and homogeneous with a yellowish area. Histological examination showed that the tumor mostly consisted of fibrotic areas with hyalinization. The typical histology of cavernous hemangioma was confirmed in part, and the tumor was diagnosed as a sclerosing hemangioma with predominancy of the sclerosed area. A review of 20 cases reported previously revealed that only 2 (10%) patients were diagnosed as having sclerosing hemangioma preoperatively.</p>","PeriodicalId":30295,"journal":{"name":"Case Reports in Hepatology","volume":"2018 ","pages":"7353170"},"PeriodicalIF":0.0,"publicationDate":"2018-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2018/7353170","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36653148","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":"Anastomotic Biliary Stricture Development after Liver Transplantation in the Setting of Retained Prophylactic Intraductal Pediatric Feeding Tube: Case and Review.","authors":"Patrick T Koo, Valentina Medici, James H Tabibian","doi":"10.1155/2018/4707389","DOIUrl":"https://doi.org/10.1155/2018/4707389","url":null,"abstract":"<p><p>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. Abdominal ultrasound revealed a linear, 1.5 mm hyperechoic filling defect in the common bile duct; magnetic resonance cholangiopancreatography demonstrated a curvilinear filling defect at the level of the choledochocholedochostomy, corresponding to the ultrasound finding, as well as an anastomotic biliary stricture (ABS). On endoscopic retrograde cholangiography (ERC), a black tubular stricture with overlying sludge was encountered and extracted from the common bile duct, consistent with a retained 5 Fr pediatric feeding tube originally placed at the time of LT. The patient experienced symptomatic and biochemical relief and successfully underwent serial ERCs with balloon dilatation and maximal biliary stenting for ABS management. With this case, we emphasize the importance of ensuring spontaneous passage or removal of intraductal prostheses placed prophylactically at the time of LT in order to minimize the risk of chronic biliary inflammation and associated sequelae, including cholangitis and ABS formation. We also provide herein a brief review of the use of prophylactic internal transanastomotic prostheses, including biliary tubes and stents, during LT.</p>","PeriodicalId":30295,"journal":{"name":"Case Reports in Hepatology","volume":"2018 ","pages":"4707389"},"PeriodicalIF":0.0,"publicationDate":"2018-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2018/4707389","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36620276","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":"Acute Liver Failure due to Disseminated Varicella Zoster Infection.","authors":"Elizabeth Caitlin Brewer, Leigh Hunter","doi":"10.1155/2018/1269340","DOIUrl":"10.1155/2018/1269340","url":null,"abstract":"<p><p>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). Antiviral treatment with intravenous acyclovir can be effective if initiated in a timely manner; however, comorbidities and complications frequently result in high mortality, especially in immunocompromised hosts as exemplified in this case presentation.</p>","PeriodicalId":30295,"journal":{"name":"Case Reports in Hepatology","volume":"2018 ","pages":"1269340"},"PeriodicalIF":0.0,"publicationDate":"2018-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6180957/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36620643","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":"Treatment of Chronic Hepatitis C Can Improve Glycemic Control in Patients with Type 2 Diabetes.","authors":"Nalan Okuroglu, Meltem Sertbas, Ali Ozdemir","doi":"10.1155/2018/5260510","DOIUrl":"https://doi.org/10.1155/2018/5260510","url":null,"abstract":"<p><p>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 4.8%, and c-peptide of 3.17 ng/ml. After achieving successfully virologic response with antiviral therapy, the patient stayed euglycemic and was no longer in need to any medication including insulin and the patient was followed only by dietary regulation. Achievement of the virological response in treatment of HCV infection can improve not only the liver status, but also the extrahepatic manifestations including type 2 DM.</p>","PeriodicalId":30295,"journal":{"name":"Case Reports in Hepatology","volume":"2018 ","pages":"5260510"},"PeriodicalIF":0.0,"publicationDate":"2018-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2018/5260510","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36577211","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":"Chronic, Recreational Chloroform-Induced Liver Injury.","authors":"Emily A Minor, Mackenzie S Newman, Justin T Kupec","doi":"10.1155/2018/1619546","DOIUrl":"https://doi.org/10.1155/2018/1619546","url":null,"abstract":"<p><p>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. An extensive work-up revealed an aspartate aminotransferase (AST) of 13,527 U/L and alanine aminotransferase (ALT) of 8,745 U/L, but the cause of his liver injury could not be determined. It was not until many months later that the patient admitted to inhaling chloroform in the weeks leading up to his illness.</p>","PeriodicalId":30295,"journal":{"name":"Case Reports in Hepatology","volume":"2018 ","pages":"1619546"},"PeriodicalIF":0.0,"publicationDate":"2018-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2018/1619546","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36541674","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}