Annals of hepatology最新文献

{"title":"Prolonged release pirfenidone restores miRNA expression and CpG island methylation in patients with HCV sustained virological response and residual liver fibrosis","authors":"Eira Cerda-Reyes ,&nbsp;Ricardo de la Rosa-Bibiano ,&nbsp;Ana Sandoval-Rodriguez ,&nbsp;Rebeca Rosas-Campos ,&nbsp;Rebeca Escutia-Gutiérrez ,&nbsp;Ángel Vázquez-Esqueda ,&nbsp;Stefanny Cornejo-Hernández ,&nbsp;Alejandro Gutiérrez-Átemis ,&nbsp;Salvador Amezquita-Pérez ,&nbsp;Jorge Luis Poo ,&nbsp;Gildardo Agustin Garrido-Sanchez ,&nbsp;Juan Ramón-Aguilar ,&nbsp;Juan Armendáriz-Borunda","doi":"10.1016/j.aohep.2025.101889","DOIUrl":"10.1016/j.aohep.2025.101889","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Patients with residual liver fibrosis after hepatitis C virus-infection clearance represent an important challenge due to the risk of progression and hepatocarcinoma development. The primary end of this study was to evaluate epigenetic marks in DAA-responders HCV non-European patients presenting remaining fibrosis. The secondary aim was to assess the efficacy of 12 months of treatment with prolonged-release pirfenidone (PR-PFD) in liver fibrosis regression.</div></div><div><h3>Materials and Patients</h3><div>Forty-four DAA-responders HCV patients presenting remaining fibrosis (73% women) were enrolled in the study and received PR-PFD (1200 mg/day) for 12 months. Six patients dropped out. Liver biopsies and serum samples were analyzed at the beginning and end of treatment. Besides, six non-fibrotic controls were included to compare epigenetics marks.</div></div><div><h3>Results</h3><div>After 12 months of treatment, 28.94% of patients showed a reduction in at least 1 fibrosis stage based on liver biopsies, while 57.57% experienced fibrosis reversion according to transient elastography. Bilirubin, alkaline phosphatase, AST, INR, and APRI values significantly decreased, and only minor adverse events were reported. Profibrogenic miRNAs displayed a significant increase in expression in advanced fibrosis versus controls without fibrosis. Noteworthy, PR-PFD treatment induced their decrease and restored the expression of miR-34a, miR-16, miR-192, miR-200a and miR-122 correlating with the downgrade of fibrosis stage. Specific PDGFa CpGs exhibited hypermethylation in both cell-free-DNA and liver biopsies in both mild and advanced fibrosis. Interestingly, four CpGs in PPARd promoter were hypomethylated versus controls. PR-PFD treatment resulted in hypermethylation in three TGFb1-CpGs after 12 months, suggesting down-regulation of this profibrogenic cytokine.</div></div><div><h3>Conclusions</h3><div>These findings suggest, for the first time, that PR-PFD might exert its therapeutic effects in Hispanic patients with residual fibrosis by modulating the expression of miRNAs and methylation of specific CpG sites.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101889"},"PeriodicalIF":3.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143896156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patterns of antimicrobial resistance and susceptibility in patients with spontaneous bacterial peritonitis at the General Hospital of Mexico \"Dr. Eduardo Liceaga\"","authors":"Gabriela Rangel-Zavala,&nbsp;Paloma M. Diego-Salazar,&nbsp;Karina Cazarín-Chávez,&nbsp;José L. Pérez-Hernández,&nbsp;Fatima Higuera-de-de-Tijera","doi":"10.1016/j.aohep.2025.101862","DOIUrl":"10.1016/j.aohep.2025.101862","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Spontaneous bacterial peritonitis (SBP) is a serious complication in cirrhotic patients, with high morbidity and mortality. Antimicrobial resistance complicates treatment and increases complications. This study aims to determine resistance patterns in microorganisms in SBP to improve treatment efficacy.</div></div><div><h3>Materials and Patients</h3><div>A descriptive, observational, and retrospective study on patterns of antimicrobial resistance and susceptibility in patients with spontaneous bacterial peritonitis was conducted at the General Hospital of Mexico “Dr. Eduardo Liceaga” between January 2022 and January 2024. Clinical information was collected from the records of the Gastroenterology Service. Microbiological results were obtained from reports from the Microbiology Service. Patients diagnosed with hepatic cirrhosis and meeting the criteria for SBP were included. Clinical and microbiological data were collected, analyzing variables such as age, sex, etiology of liver disease, and associated decompensations, such as gastrointestinal bleeding and hepatic encephalopathy. Antimicrobial resistance patterns, as well as clinical and microbiological characteristics of patients with SBP, were examined. This analysis aims to contribute to the optimal management of SBP and the development of more effective antimicrobial treatment strategies.</div></div><div><h3>Results</h3><div>A total of 48 patients were included, 52.1% were men, with a mean age of 52.4 ± 12.7 years. The predominant etiology of cirrhosis was alcohol, present in 56.3% of cases. Among the isolated bacteria, Escherichia coli (56.25%), Klebsiella pneumoniae (12.5%), Enterococcus faecalis (6.25%), Streptococcus spp. (6.25%), Staphylococcus epidermidis (4.16%), Staphylococcus aureus (4.16%), Enterococcus gallinarum (4.16%), Staphylococcus marcescens (2.08%), Acinetobacter sobria (2.08%), and Staphylococcus haemolyticus (2.08%) were prominent. The sensitivity and resistance table to different antimicrobials are presented in Graph 1.</div></div><div><h3>Conclusions</h3><div>Antimicrobial resistance is increasing in patients with SBP, leaving few effective alternatives, where cephalosporins and quinolones, recommended treatments, are no longer sufficiently useful, which is dangerous in the context of empirical therapy given the high risk of therapeutic response failure.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101862"},"PeriodicalIF":3.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143896006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ischemic Hepatitis and Cardiac Tamponade, a rare association.","authors":"María E. Hernández-Ortega,&nbsp;Viridiana Ramírez Villagrán,&nbsp;Thania B. Zurita-Cruz,&nbsp;Oscar J. Tercero-Colmenares","doi":"10.1016/j.aohep.2025.101866","DOIUrl":"10.1016/j.aohep.2025.101866","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction and Objectives&lt;/h3&gt;&lt;div&gt;Ischemic hepatitis transiently elevates aminotransferases due to reduced oxygen delivery to the liver. The most common cause is heart failure&lt;sup&gt;1&lt;/sup&gt;. Cardiac tamponade is an accumulation of pericardial fluid that can cause hemodynamic compromise&lt;sup&gt;2&lt;/sup&gt;. The association of both is unusual, which is why it is important to identify them.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Materials and Patients&lt;/h3&gt;&lt;div&gt;A 50-year-old patient with a history of type 2 diabetes, systemic arterial hypertension and chronic kidney disease, presented in November 2023 due to hypotension with data of low output during a hemodialysis session, adding dyspnea on minor exertion and abdominal pain located in the right hypochondrium. Upon admission with hemodynamic instability, it was decided to start vasopressor support. In laboratory studies, it presents elevated aminotransferases (Alanine aminotransferase at 1947 U/L and aspartate aminotransferase at 2649 U/L), lactate at 5 mmol/L, lactic dehydrogenase at 2166 U/L and elevated INR at 3.15. An ultrasound of the liver and bile ducts was performed, reporting parenchyma with increased echogenicity and pericardial effusion. An evaluation was requested by Cardiology, performing a transthoracic echocardiogram, showing severe pericardial effusion with a separation of up to 34 mm in the basal region. Pericardiocentesis was performed with the extraction of 850 milliliters of pericardial fluid. As part of the approach, viral and autoimmune etiology was ruled out as a cause of liver disease. PCR for Mycobacterium tuberculosis in the pericardial fluid was requested with a negative report and no malignancy data in the pericardial effusion approach. Patient with clinical improvement and progressive decrease in transaminase levels until normalization.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Ischemic hepatitis has been associated with cardiovascular diseases. The pathogenesis of ischemic hepatitis appears to occur as a result of two mechanisms, when the liver that is at risk is subsequently exposed to systemic hypoperfusion and ischemia, ultimately resulting in a marked but transient elevation of aminotransferases&lt;sup&gt;3&lt;/sup&gt;. The diagnosis is largely clinical and uses three criteria, a clinical setting of cardiac, circulatory, or respiratory failure, transient increase in serum aminotransferase activity, and exclusion of other causes of liver cell necrosis, especially viral hepatitis or induced drugs hepatitis&lt;sup&gt;1&lt;/sup&gt;. Other abnormal laboratory findings may be found in patients with ischemic hepatitis, such as increased lactic dehydrogenase levels, reduced prothrombin activity, increased serum creatinine, serum bilirubin, and serum lactate levels, due to an abnormal hepatic clearance. Non-invasive imaging options, such as abdominal ultrasound, may aid in the diagnosis of ischemic hepatitis. Dilatation of the inferior vena cava and suprahepatic veins due to passive congestion suggests this. However, the","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101866"},"PeriodicalIF":3.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143896011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary Hepatic Lymphoma Associated with HIV, Case Report.","authors":"Luz A. Torres-López,&nbsp;Mónica M. Santamaría-Chávez,&nbsp;Leonardo D. De la Torre-Carmona,&nbsp;Omar G. Blancas-Reyes","doi":"10.1016/j.aohep.2025.101871","DOIUrl":"10.1016/j.aohep.2025.101871","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Primary liver lymphoma (PLL) is a rare form of lymphoma. It represents 1% of all non-Hodgkin lymphomas and 0.4% of extra nodal lymphomas. Risk factors include infection with human immunodeficiency virus (HIV), hepatitis B and C, as well as chronic immunosuppression. Here, we present a case of PLL.</div></div><div><h3>Materials and Patients</h3><div>A 39-year-old male with HIV infection and recently diagnosed disseminated Kaposi's sarcoma was admitted due to abdominal pain, asthenia, adynamia, and a 10 kg weight loss. Physical examination revealed a painful abdomen, hepatomegaly of 3 cm below the costal margin, and no other abnormalities. An exophytic, violaceous palatine tumor was observed in the oral cavity. Laboratory studies showed: total bilirubin 1.3, direct bilirubin 1, aspartate aminotransferase 23, Alanine transaminase 20, alkaline phosphatase 519, Gamma-glutamyltransferase 392, lactate dehydrogenase 271. A CT scan reported multiple hypodense oval images in hepatic segments III to VIII with a hypodense center in the contrast phase and ring enhancement; an amorphous, irregularly bordered mass occupying the soft palate extending to the nasal cavity; no splenomegaly or lymphadenopathies. An ultrasound-guided liver biopsy revealed lymphocyte proliferation with severe atypia consistent with lymphoma, which immunohistochemistry confirmed as diffuse large B-cell lymphoma of germinal center origin with a double-expressor immunophenotype (C-MYC &gt; 40%, BCL2 &gt; 50%). A biopsy of the palatal lesion reported ulcerated Kaposi's sarcoma. Endoscopy and colonoscopy showed circumscribed mucosal elevations in the cecum and stomach; histopathology reported Kaposi's sarcoma.</div></div><div><h3>Results</h3><div>Extension studies were conducted with serology for hepatitis B and C viruses and cytomegalovirus, all of which returned negative results. The bone marrow biopsy showed no lymphomatous infiltration, and the lumbar puncture revealed no abnormalities. The dissemination study with computed tomography of the chest, abdomen, and pelvis did not reveal findings suggestive of supradiaphragmatic or infradiaphragmatic involvement. The diagnosis of primary hepatic double-expressor lymphoma was concluded, synchronous with diffuse Kaposi's sarcoma. Antiretroviral therapy was initiated for 2 weeks, followed by the first cycle of chemotherapy with the EPOCH-DA regimen. The patient experienced progressive deterioration that ultimately led to his death.</div></div><div><h3>Conclusions</h3><div>LHP is an uncommon entity, just as Kaposi's sarcoma are common neoplasms associated with HIV and immunodeficiencies. Synchronous presentation is poorly documented, with only isolated cases reported in the literature. Therefore, it is important to conduct a comprehensive approach for the identification and timely management of these conditions</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101871"},"PeriodicalIF":3.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143895936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hyperonitinemia-Hyperammonemia-Homocitrullinuria syndrome. Neonatal presentation with acute liver failure.","authors":"César U. Amaro-Reynoso,&nbsp;Jose L. Flores-Castillo,&nbsp;Catherine N. Pineda-Cely,&nbsp;Rodrigo Vázquez-Frías","doi":"10.1016/j.aohep.2025.101792","DOIUrl":"10.1016/j.aohep.2025.101792","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Urea cycle defects occur in 1/35,000 live births and Hyperonitinemia-Hyperammonemia-Homocitrullinuria (HHH) syndrome represents 1-4% of this group of diseases, which represents an autosomal recessive defect due to variants of the SLC25A15 gene. The present work describes the first case of HHH syndrome reported in Mexico.</div></div><div><h3>Materials and Patients</h3><div>We present a 5-month-old female infant, daughter of the second pregnancy of non-consanguineous parents, originally from Quintana Roo, born at term with intrauterine growth restriction, presented early neonatal sepsis and required ventilatory and hemodynamic treatment, in the second week she presented Cholestasis with normal GGT, coagulopathy, which did not correct after treatment with vitamin K, and irritability with hyperammonemia up to 640umol/L, which led to the diagnosis of neonatal acute liver failure.</div><div>At the initial approach, infectious etiology was ruled out, with high suspicion of gestational alloimmune liver disease, due to the presence of elevations of alpha-fetoprotein 12,410ng/mL and ferritin 1,590ng/mL. Gaucher disease, Niemann Pick, and lysosomal acid lipase deficiency were ruled out. Metabolic screen with hyperornithinemia (435.79 mmol/L). The genetic study found a pathogenic variant in a homozygous state of the acceptor site of the splicing of intron 2 of the SLC25A15 gene.</div><div>Two doses of human immunoglobulin and supportive treatment for liver failure with menadione and ammonium binders were administered with a favorable therapeutic response; the liver failure was remitted 4 weeks after the established management.</div></div><div><h3>Results</h3><div>The present work describes the first case of HHH syndrome reported in Mexico, which presented with neonatal acute liver failure associated with two of the three biochemical characteristics described due to hyperammonemia and hyperornithinemia. Likewise, a homozygous variant was identified in SLC25A15 and classified as pathogenic.</div></div><div><h3>Conclusions</h3><div>This report highlights the first documented case of HHH syndrome in Mexico, emphasizing its association with neonatal acute liver failure, hyperammonemia, and hyperornithinemia. The identification of a pathogenic homozygous variant in the SLC25A15 gene reinforces the importance of genetic studies for early diagnosis and targeted management of urea cycle disorders.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101792"},"PeriodicalIF":3.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143896048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Liver alterations found in patients with inflammatory bowel disease in a tertiary care center.","authors":"Kenia M. Bastida-Guadarrama ,&nbsp;Jorge Luis De-León-Rendón ,&nbsp;Viridiana López-Ladrón-de-Guevara ,&nbsp;Santiago Camacho-Hernandez ,&nbsp;Fátima Higuera-de-la-Tijera","doi":"10.1016/j.aohep.2025.101799","DOIUrl":"10.1016/j.aohep.2025.101799","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Inflammatory bowel disease (IBD) encompasses two main conditions: Crohn's disease (CD) and ulcerative colitis (UC); the association between these diseases and liver diseases has been described. The objective of this work is to report the frequency of these alterations in a tertiary hospital.</div></div><div><h3>Material and Patients</h3><div>Observational, retrospective, descriptive, case series type. Patients with a diagnosis of IBD were included, including its two variants, CD and UC. An intentional search was carried out for alterations in the liver biochemical profile, findings in imaging methods and their clinical correlation, primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC), autoimmune hepatitis (AIH), among other anatomical alterations. Qualitative data are expressed in percentages and quantitative data in mean±SD.</div></div><div><h3>Results</h3><div>62 patients were included, of which 31 were men and 31 were women, with a mean age of 42.74±15.47 years. Within this universe, there were 22 patients with CD (35.4%), 40 patients with UC (64.5%) who, according to the Montreal classification, were classified as E1=4 patients (10%), E2=12 patients (30%), E3=24 patients (60%). There were 16 patients (25.8%) who had some reported liver alteration, of which 8 (12.9%) with autoimmune liver diseases, 5 with PSC (8.06%), 2 with PBC (3.22%), 1 with HAI (1.61%). When intentionally searching for liver morphological alterations and as an incidental finding, they were found 3 (4.83%) simple hepatic cysts, 1 (1.61.%) hepatic hemangioma, and finally, 2 (3.22%) hepatitis C virus (HCV) infections.</div></div><div><h3>Conclusions</h3><div>IBD is commonly associated with autoimmune liver disorders. Likewise, the CUCI-PBC and CUCI-HAI relationship was found, which agrees with the international literature and is extrapolated with the population studied. Other incidental findings are also frequent, especially the high frequency of HCV compared to the general population.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101799"},"PeriodicalIF":3.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143896074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atypical migratory reactive arthritis related to Hepatitis C Virus","authors":"Clara C. Sánchez-Rodríguez ,&nbsp;Ana M. Mendoza-Martínez ,&nbsp;Héctor R. Sánchez-Nuncio ,&nbsp;Jorge H. Luna-Domínguez","doi":"10.1016/j.aohep.2025.101801","DOIUrl":"10.1016/j.aohep.2025.101801","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Reactive arthritis (RA) occurs after bacterial infections and is sporadically associated with enterovirus and hepatitis B virus (HBV) and hepatitis C virus (HCV). Clinically, we observe the characteristic triad of arthritis, uveitis and urethritis or diarrhea. We present a patient with RA associated with HCV.</div></div><div><h3>Materials and Patients</h3><div>Fifty-three-year-old man with a history of cannabis use as a youth, suspended 15 years ago. He begins with conjunctival injection, ocular pruritus, increased conjunctival secretion with ocular foreign body sensation, dysuria, and foamy urine. After 24 hours, there was pain, redness, increased volume and significant limitation of the left glenohumeral joint. He received non-steroidal anti-inflammatory drugs (NSAID) with a poor response. Seventy-two hours later, he presented pain in the right coxofemoral joint and 48 hours later in the right knee with increased volume. heat and redness with expansion of the edema to the right lower extremity, highlighting the pain in the ankle, knee and hip joints, which is why he went to the emergency room with suspicion of thrombosis (Image 1).</div></div><div><h3>Results</h3><div>During his hospitalization, a Doppler ultrasound of the lower extremity was performed, ruling out venous thrombosis. The left knee was punctured, obtaining transparent liquid with characteristics of transudate, acellular without bacteria in the biochemical analysis. Serum analysis, general urine analysis, urine culture, VDRL, antibodies against human immunodeficiency virus (HIV), antibodies against hepatitis C virus (Ac vs. HCV), hepatitis B surface antigen (HBVAg) and acute phase reactants (Image 2). Active bacterial infection was excluded, and he received 0.9% saline solution and 150 mg intravenous methylprednisolone every 12 hours, with improvement of symptoms and resolution of uveitis. Active infection with HCV was detected and the patient was discharged with 14 more days on prednisone 10 mg every 24 hours. As an outpatient, he received sofosbuvir/velpatasvir for 12 weeks with sustained viral response at week 12 (SVR12).</div></div><div><h3>Conclusions</h3><div>HCV can induce systemic inflammatory conditions and simulate other infections, such as, in this case, those associated with sexually transmitted bacteria, so it is important to request the Ac vs HCV and, if they are reactive, verify viral replication to administer specific treatment with direct-acting antivirals.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101801"},"PeriodicalIF":3.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143896076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between autoimmune hepatitis and leukocytoclastic vasculitis, a case report","authors":"Yajzeel Estevez-Lopez ,&nbsp;Sury Z. Palma-Motte ,&nbsp;Mary C. Jimenez-Prieto ,&nbsp;Raquel Ramirez-Carrillo ,&nbsp;Maria F. Reyes-Romero ,&nbsp;Felipe de J. Duarte-Grajales","doi":"10.1016/j.aohep.2025.101877","DOIUrl":"10.1016/j.aohep.2025.101877","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction and Objectives&lt;/h3&gt;&lt;div&gt;Autoimmune hepatitis has an incidence that ranges from 0.9-2%. It is usually associated with other liver diseases and other autoimmune disorders, however, there are few cases associated with leukocytoclastic vasculitis. Now we present the case of an association between autoimmune hepatitis and leukocytoclastic vasculitis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Materials and Patients&lt;/h3&gt;&lt;div&gt;This is a female patient who presented constant pain in the right hypochondrium since 2019, intermittent fever with nocturnal presentation.&lt;/div&gt;&lt;div&gt;In the Personal pathological history, she reported that was healthy, had an uncomplicated pregnancy, had no history of traveling outside the country or visiting caves, had no family history of autoimmune, genetic, or infectious diseases, had no history of exposure to chemical substances or people with a diagnosis of tuberculosis. During the years 2019 to 2024, in addition to pain in the hypochondrium and fever, they presented myalgia, arthralgia, morning stiffness that improves with activity with signs of inflammatory pain, facial erythema, and maculopapular skin rashes on the hands and legs on sun exposure. She presented Eye with foreign body sensation, and we referred to rheumatology, considering the possibility of systemic lupus erythematosus and Sjögren's syndrome, complementary studies were performed, and she was sent to ophthalmology where a normal tear breakup time of less than 5 seconds was concluded. and Sjögren's Syndrome is ruled out. Antibodies are performed to rule out systemic lupus erythematosus, such as Anti DNA and Anti SM, being negative.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;We performed a diagnostic approach in a patient with constitutional symptoms, skin rashes and constant pain in the right upper quadrant. Complementary imaging studies were requested such as USG of the liver and CT scan of the abdomen, both of which showed signs of cirrhosis, so autoimmune hepatitis began to be suspected. Within the liver studies, the transaminases are normal, alkaline phosphatase elevated, and hyperglobulinemia. Protein electrophoresis with immunofixation was performed, being positive for HyperGammaglobulinemia, subsequently, biopsies of the lip, liver and skin lesions were taken. Amylodosis and Sjögren's syndrome were ruled out with these studies, however the skin lesions demonstrated leukocytoclastic vasculitis and the antibody studies showed positive ANA, with AMA, ANCA, DNA, SM negative, and the liver biopsy showed findings related to autoimmune hepatitis. Therefore, by ruling out connective tissue and associated oncological diseases, the diagnosis of autoimmune hepatitis was established, since when using the simplified diagnostic criteria of the International Autoimmune Hepatitis Group, 8 points were met, thus confirming the diagnosis of this entity. Due to hypergammaglobulinemia, hematological diseases were ruled out when bone marrow aspiration and biopsy were performed.&lt;/di","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101877"},"PeriodicalIF":3.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143895769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterization of the inflammatory profile in patients with compensated and decompensated liver cirrhosis through cytosines determined by spectroscopy.","authors":"Carlos E. Coronel-Castillo ,&nbsp;Gustavo J. Vázquez-Zapien ,&nbsp;Mónica M. Mata-Miranda ,&nbsp;Eira Cerda-Reyes ,&nbsp;Adriana Martínez-Cuazitl","doi":"10.1016/j.aohep.2025.101882","DOIUrl":"10.1016/j.aohep.2025.101882","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction and Objectives&lt;/h3&gt;&lt;div&gt;Inflammatory cytokines influence the progression of cirrhosis and decompensation. The study aims to characterize the inflammatory response of patients with compensated and decompensated liver cirrhosis through inflammatory cytokines and evaluate the state of the disease, type of decompensation, severity and the development of acute on chronic liver failure.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Materials and Patients&lt;/h3&gt;&lt;div&gt;Hospitalized patients with a diagnosis of compensated and decompensated liver cirrhosis were included. Upon admission, saliva samples were collected in microcentrifuge tubes to measure cytosines (IL-6, IL-1β, IL-10, ILF-γ and TNF), lipids and immunoglobulins: A, M and G using Fourier transform infrared spectroscopy (FTIR). Clinical and biochemical variables (complete blood count, blood chemistry, liver biochemistry, serum electrolytes, lipid profile and C-reactive protein), MELD 3.0 and Child Pugh scales were included. The statistical analysis was used the SPSS V24 program for continuous quantitative variables expressed in measures of central tendency and dispersion according to the normality of the data, the ordinal quantitative variables were expressed in frequencies and percentages, Spearman correlation analysis and a linear regression analysis were performed, from which a ROC curve and the Youden's J statistic and its sensitivity and specificity were determined, with a statistically significant p &lt;0.05.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;It was included 40 patients: 19 compensated and 21 decompensated. The most common decompensation was hepatic encephalopathy. (20%) (MELD 3.0 12.5 ± 3.59 vs 21.61 ±7.47, p&lt;0.000). Statistical significance was found in leukocytes, neutrophils and INR as well as differences in the levels of IgG, IgM, IL-6, IL1β, IFN-γ and IL-10 between the causes of decompensation (Figure 1) and decreased IgM levels. And IFN-γ in decompensated patients compared to compensated patients. A negative correlation was found between neutrophil levels and IgM, IL6, IL1β, IL10 and IFN-γ levels. The linear regression analysis gave the following formula m= 2.648+ (-0.267*infection) + (-0.926*abs1) + (0.084*abs2) + (0.442*abs3) + (-0.051*abs12) + (0.005*IgM) + (-0.064*IFNγ) + (-0.2*Leukocytes) + (0.223*Neutrophils) + (0.006*Urea), R=0.623. With the same formula, AUROC: 0.877 and p value &lt;0.0001, Youden's J statistic cutoff of 1.3913, obtaining sensitivity of 92.1%, and specificity of 78.9%. The correlation with Child-Pugh is negative with IgM levels, while it was no association between the presence of infection and decompensation (X&lt;sup&gt;2&lt;/sup&gt;= 0.053, p= 0.818), an association was indeed observed between Child-Pugh and the presence of infection (X&lt;sup&gt;2&lt;/sup&gt;= 15.126, p= 0.001).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;No correlation was found between levels of IgG, IL-6, IL1β, IFN-γ and IL-10 and the MELD 3.0 and Child Pugh scales, there is only a correlation between the Child P","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101882"},"PeriodicalIF":3.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143895785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cholestatic Injury Induced by Naproxen: A Rare Cause of NSAID-Induced Hepatotoxicity. Case Report.","authors":"Héctor M. Herrera-Martínez ,&nbsp;Erika G. Salgado-Parra ,&nbsp;Brenda N. Loza-Hernandez ,&nbsp;Arturo Rodriguez-Guajardo ,&nbsp;Byron I. Argoti-Mosquera","doi":"10.1016/j.aohep.2025.101828","DOIUrl":"10.1016/j.aohep.2025.101828","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction and Objectives&lt;/h3&gt;&lt;div&gt;Naproxen-induced liver injury is very rare (1-3 cases per 100,000 exposed individuals), typically occurring 1-6 weeks after ingestion¹. The damage can manifest with or without immunoallergic features and varying degrees of hepatocellular injury and cholestasis². We illustrate a case of a patient who developed cholestatic injury.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Materials and Patients&lt;/h3&gt;&lt;div&gt;A 51-year-old man, with the only relevant history being self-prescribed ingestion of 220 mg gel capsules of naproxen sodium two weeks prior for post-exercise muscle pain, presented on 04/05/24 with asthenia, vague abdominal pain in the right hypochondrium, jaundice, acholia, and dark urine. He sought medical emergency services two days later, where pronounced mucocutaneous jaundice, hepatomegaly, and hepatodynia were observed. Paraclinical tests showed hyperbilirubinemia: total bilirubin (TB) elevated due to direct bilirubin (DB), marked elevation of alkaline phosphatase (AP) and gamma-glutamyl transferase (GGT), and slight elevation of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) (R factor = 2 mixed). Hepatic and biliary tract ultrasound reported diffuse increased hepatic echogenicity, ruling out biliary tract obstruction. Serological testing for hepatotropic viruses and TORCH screen were negative, as was the serological profile for autoantibodies. A percutaneous ultrasound-guided liver biopsy was performed; biopsies demonstrated intrahepatic cholestasis, minimal and focal lobular and portal interface hepatitis, macrovesicular steatosis; special stains negative for hemosiderin and glycogen deposits, fibrosis and copper-bound proteins; suggested of drug induced liver damage &lt;strong&gt;(Figure 1)&lt;/strong&gt;.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Drug-induced liver injury is a diagnosis of exclusion, only to be suspected when major causes of liver damage have been ruled out. Naproxen, a non-steroidal anti-inflammatory drug (NSAID) derived from propionic acid, has been reported to cause hepatotoxicity phenotypes of hepatocellular injury (acute hepatitis) and cholestasis through metabolic, immunoallergic and idiosyncratic mechanisms³. In this patient, the toxicity was non-dose-dependent, with an acute presentation characterized by a predominant elevation of cholestatic markers. Only supportive measures were provided, with close clinical and biochemical monitoring to identify early signs of liver dysfunction. The patient showed favorable evolution towards remission, characterized by symptomatic improvement and a progressive decrease in cholestatic markers within the first few days &lt;strong&gt;(Figure 2)&lt;/strong&gt;. After nine days of hospitalization, discharge was decided due to improvement, with a follow-up appointment for continued monitoring.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;In suspected naproxen-induced cholestatic injury, a liver biopsy is not required for diagnosis⁴ but is useful for understanding etiology","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101828"},"PeriodicalIF":3.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143896141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}