{"title":"Chronic Hepatitis C with Cyanosis.","authors":"Mahmood Alawainati, Jawad Khamis, Muneer Abdulla, Saeed Alsaeed","doi":"10.1155/2019/6586478","DOIUrl":"https://doi.org/10.1155/2019/6586478","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Case presentation: </strong>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. The initial impression of pulmonary embolism was excluded by comprehensive diagnostic investigations. The correlation between the clinical picture and investigations raised the possibility of hepatopulmonary syndrome which was confirmed by contrast-enhanced transthoracic echocardiography.</p><p><strong>Conclusions: </strong>High suspicion is required to diagnose hepatopulmonary syndrome in patients with liver disease and hypoxemia. Screening for this complication is appropriate in liver transplant candidates, and diagnosed patients should be evaluated extensively for liver transplant.</p>","PeriodicalId":30295,"journal":{"name":"Case Reports in Hepatology","volume":"2019 ","pages":"6586478"},"PeriodicalIF":0.0,"publicationDate":"2019-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2019/6586478","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36941378","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 Invasive Cryptococcal Infection in an HIV-Negative Elderly Patient with Decompensated Hepatic Cirrhosis.","authors":"Shigeru Koba, Kazuki Ueda, Masahiro Mori, Kenji Miki, Shinsaku Imashuku","doi":"10.1155/2018/5174518","DOIUrl":"https://doi.org/10.1155/2018/5174518","url":null,"abstract":"<p><p>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. During hospitalization, she was found to have pleural effusion and ascites. <i>Cryptococcus neoformans</i> was obtained from blood culture but not from pleural effusion culture. Consequently, the patient was diagnosed as having invasive cryptococcosis in association with HBV-related hepatic cirrhosis. Unfortunately, the patient died prior to receiving antifungal agents. Twelve Japanese cases of hepatic cirrhosis-related invasive cryptococcal infection, consisting of previously described and this case, were summarized for discussion of the clinical features and outcomes.</p>","PeriodicalId":30295,"journal":{"name":"Case Reports in Hepatology","volume":"2018 ","pages":"5174518"},"PeriodicalIF":0.0,"publicationDate":"2018-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2018/5174518","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36896926","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}
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}