Hemophagocytic syndrome after living-donor liver transplantation for fulminant liver failure: a case report

Hemophagocytic syndrome (HPS) is a hypercytokinemia caused by activated T lymphocytes and macrophages in immunologically compromised patients. We report a 37-year-old female who was diagnosed with HPS after undergoing living-donor liver transplantation (LDLT) for fulminant liver failure of unknown etiology. After liver transplantation, recipients with pancytopenia should be tested for serum ferritin. When the serum ferritin is abnormal, the bone marrow should be biopsied to screen for HPS as soon as possible. If the condition is caught early and promptly treated, the outcome of this devastating condition might be improved. In addition, HPS should be ruled out in LDLT candidates with acute liver failure before their operations.     

Fulminant hepatic failure after repeated exposure to isoflurane anesthesia: a case report

A previously healthy but obese 26-yr-old woman was diagnosed as having hepatic dysfunction 17 days after the third of three consecutive exposures to isoflurane anesthesia for paranasal sinus surgery. Serum laboratory findings included elevated aminotransferases and bilirubin. Radiographical evaluations showed no evidence of extrahepatic disease. Serological studies were negative for acute viral infections, and serum copper was normal. The patient's condition deteriorated over the ensuing 17 days, with hyperreflexia, hypoglycemia and a rapid fall in serum aminotransferases with a concomitant rise in bilirubin level and prothrombin time despite maximal medical support. The liver volume as shown by computed tomography fell from 1,290 cm3 to 680 cm3 over 6 days. The patient underwent successful orthotopic liver transplantation 25 days after onset of symptoms. Histopathological examination of the resected liver showed submassive and massive necrosis, with a few foci of microvesicular steatosis and ultrastructural evidence of mitochondrial abnormalities. Although we found insufficient evidence to prove that this case was caused by isoflurane anesthesia, the clinical course and histopathological findings are similar to those in hepatic injury caused by halothane anesthesia. Therefore we report this as a possible case of fulminant hepatic failure resulting from isoflurane anesthesia.     

Clozapine-induced fatal fulminant hepatic failure: A case report

Fulminant hepatic failure (FHF) refers to the rapid development of severe acute liver injury with impaired synthetic function and encephalopathy in a person who previously had a normal liver or had well-compensated liver disease. The potential causes of FHF are numerous, but viral or toxin-induced hepatitis are the most common. Clozapine-induced hepatotoxicity has rarely been reported in the literature, occurs via an unknown mechanism and results in liver biochemical abnormalities that are usually of no clinical significance. In approximately 30% to 50% of patients treated with clozapine, there is an asymptomatic rise in serum aminotransaminase levels; however, there are no current guidelines for routine monitoring of liver function tests and liver enzymes during its use. Fatal fulminant hepatitis has only been reported in three patients receiving clozapine. A case of fatal FHF that occurred in a schizophrenic woman who began clozapine therapy shortly before her illness developed is described.     

EBV-induced fulminant hepatic failure: favorable outcome after liver transplantation

Viral hepatitis are the leading cause of fulminant hepatitis. Epstein Barr virus is the viral agent involved in infectious mononucleosis, associated with a frequent and usually benign hepatitis, except in case of immunodeficiency, congenital or acquired. We report the case of an immunocompetent young woman who presented an EBV induced fulminant hepatic failure, requiring liver transplantation that was successful. This observation emphasizes that EBV must be known as a possible cause of fulminant hepatitis and that liver transplantation is probably the unique therapeutic option to avoid a usually fatal course.     

Prolonged survival after liver transplantation for Hodgkin's disease-induced fulminant liver failure

A 30-year-old male with a past history of nodular lymphocyte predominance Hodgkin's disease in apparent complete remission for two years received a liver transplantation because of fulminant liver failure. Histopathological examination of the explanted liver showed massive infiltration by Hodgkin's disease. In spite of a nodal recurrence of Hodgkin's disease, the patient is alive and in excellent general condition six years after liver transplantation.     

Acute liver failure secondary to acute antibody mediated rejection after compatible liver transplant: A case report

BACKGROUNDThe liver has traditionally been regarded as resistant to antibody-mediated rejection (AMR). AMR in liver transplants is a field in its infancy compared to kidney and lung transplants. In our case we present a patient with alpha-1-antitrypsin disease who underwent ABO compatible liver transplant complicated by acute liver failure (ALF) with evidence of antibody mediated rejection on allograft biopsy and elevated serum donor-specific antibodies (DSA). This case highlights the need for further investigations and heightened awareness for timely diagnosis.CASE SUMMARYA 56 year-old woman with alpha-1-antitrypsin disease underwent ABO compatible liver transplant from a deceased donor. The recipient MELD at the time of transplant was 28. The flow cytometric crossmatches were noted to be positive for T and B lymphocytes. The patient had an uneventful recovery postoperatively. Starting on postoperative day 5 the patient developed fevers, elevated liver function tests, distributive shock, renal failure, and hepatic encephalopathy. She went into ALF with evidence of antibody mediated rejection with portal inflammation, bile duct injury, endothelitis, and extensive centrizonal necrosis, and C4d staining on allograft biopsy and elevated DSA. Despite various interventions including plasmapheresis and immunomodulating therapy, she continued to deteriorate. She was relisted and successfully underwent liver retransplantation.CONCLUSIONThis very rare case highlights AMR as the cause of ALF following liver transplant requiring retransplantation.     

Acute liver failure due to herpes simplex virus: diagnostic clues and potential role of plasmapheresis: A case report

Introduction:Acute liver failure (ALF) is a life-threatening condition that remains challenging for physicians despite several advances in supportive care. Etiologies vary worldwide, with herpes simplex virus (HSV) hepatitis representing less than 1% of cases. Despite its low incidence, ALF is a lethal cause of acute necrotizing hepatitis and has a high mortality. Early antiviral treatment is beneficial for survival and decreased liver transplantation necessity. However, plasmapheresis, despite its theoretical potential benefit, is scarcely reported.Patient concerns:A 25-year-old woman with no known disease presented with painful pharynx ulcers, increased transaminases and impaired liver function.Diagnosis:ALF due to a disseminated HSV-2 primary infection was diagnosed with a positive polymerase chain reaction for HSV-2 in the biopsied liver tissue and blood.Interventions:Empiric antiviral treatment was initiated. After clinical deterioration, plasmapheresis was also initiated.Outcomes:After 6 cycles of plasmapheresis and supportive care, the patient''s condition improved without undergoing liver transplantation.Conclusions:ALF is a life-threatening condition, and HSV as an etiology must be suspected based on background, clinical manifestation, and laboratory information. The potential role of plasmapheresis in HSV hepatitis should be considered.     

Atypical genital herpes: report of five cases

Manifestations of human genital herpes virus (HSV) infection are not limited to the typical cluster of genital lesions. Here we present 5 case histories suggestive to clinically atypical genital herpes (HSV detected with the polymerase chain reaction) collected in 2001 from a private outpatient clinic specializing in dermatological and venereal diseases. The clinical presentations included mucopurulent cervicitis, haemorrhagic cystitis, recurrent urethritis, and lower back pain.     

A case of fulminant liver failure associated with hepatitis C virus

Fulminant hepatitis due to acute hepatitis C virus (HCV) infection is rarely observed. We present a case study of a 21-year-old male patient who developed HCV-associated fulminant hepatitis after receiving steroid pulse therapy for optic neuritis. Despite daily plasmapheresis, the disease progressed to irreversible liver failure with grade 3 hepatic encephalopathy by the 6th day after symptom onset. The patient received a liver transplant on the 8th day. Serum anti-HCV antibody was negative at that time, but became positive on the 12th day. Positive HCV RNA in the serum at admission was reported after transplantation. Positive changes in anti-HCV antibodies and acute hepatitis with massive necrosis in the histology of the explanted liver indicated fulminant hepatitis due to acute HCV infection. Because of severe hepatitis recurrence, he started 12 months of interferon therapy on the 48th day, and obtained sustained virological response. His anti-HCV antibodies became negative again by 1.5 years after cessation of therapy. HCV genomes recovered from the patient’s serum on the 7th and 48th days revealed 2 different clones out of 20 clones with 30 % amino acid difference in hypervariable region 1 of HCV second envelope glycoprotein. One of the 2 clones expanded further after liver transplantation. We conclude that early diagnosis of HCV-associated fulminant hepatitis requires the detection of HCV RNA in the serum. Severe hepatitis recurrence after liver transplantation might occur in patients with fulminant hepatitis due to HCV because of its monoclonal expansion.     

会阴脓肿引发慢加急性肝衰竭1例

患者,男,42岁,因5 d前饮酒后出现恶心呕吐症,于2005-07-06收入院,住院期间患者因痔疮、肛瘘感染导致左侧阴囊蜂窝组织炎、会阴脓肿,高热不退,进而引发肝功能衰竭,经手术后病情得到好转.     

Mercury as a cause of fulminant hepatic failure in a child: case report and literature review

Fulminant hepatic failure (FHF) in children is devastating unless urgent liver transplantation is undergone. Intoxication or drug-related FHF is a well-known group of causes leading to FHF. Mercury intoxication is described in the literature to cause hepatitis but not described to cause DRESS (drug reaction with eosinophilia and systemic symptoms) syndrome and FHF in the same patient. We describe a child with mercury intoxication and FHF with clinical features fulfilling DRESS syndrome criteria. To our best knowledge, this is the first case report of fatal acute liver failure secondary to mercury intoxication in the English literature. Mercury intoxication should receive a worldwide attention to its consequences in order to minimize the morbidities and mortalities that arise from its intoxication.     

Pregnant woman with fulminant hepatic failure caused byhepatitis B virus infection： A case report

AIM: To report the experience in successfully treating pregnant women with severe hepatitis. METHODS: Comprehensive medical treatments were performed under strict monitoring. RESULTS: Pregnant woman with severe hepatitis was successfully rescued. CONCLUSION: Vital measures taken in the treatment of pregnant women with severe hepatitis include termination of the pregnancy at a proper time and control of various complications, such as disseminated intravascular coagulation (DIC), hepatorenal syndrome, hepatic encephalopathy and infection.     

老年心力衰竭并发肝功能衰竭抢救成功1例

1位75岁急性心衰患者入院后发现合并肝功能衰竭,经多巴胺升压、硝酸甘油扩冠等改善心功能治疗,并且联合还原型谷胱甘肽、美能、思美泰等保肝降酶治疗,1个月后患者转危为安。     

Therapy related acute myeloid leukemia after exposure to 5-Fluorouracil: a case report

Therapy related acute myeloid leukemia occurs after exposure to various cytotoxic agents. Among typical chemotherapeutic agents are the alkylating agents and topoisomarese II inhibitors. This type of leukemia has been reported after the use of antimetabolites. We report here a patient who developed therapy related acute myeloid leukemia secondary to the use of 5-fluorouracil.     

Therapy related acute myeloid leukemia after exposure to 5-Fluorouracil: a case report

Therapy related acute myeloid leukemia occurs after exposure to various cytotoxic agents. Among typical chemotherapeutic agents are the alkylating agents and topoisomerase II inhibitors. This type of leukemia has been reported after the use of antimetabolites. We report here a patient who developed therapy related acute myeloid leukemia secondary to the use of 5-fluorouracil.     

Metastatic liver disease and fulminant hepatic failure: presentation of a case and review of the literature

Although liver metastases are commonly found in cancer patients, fulminant hepatic failure (FHF) secondary to diffuse liver infiltration is rare. Furthermore, clinical presentation and laboratory findings are obscure and far from being pathognomonic for the disease. We report a case of a patient who died in the intensive care unit of our hospital from multiple organ failure syndrome secondary to FHF, as a result of liver infiltration from poorly differentiated small cell lung carcinoma. We also present the current knowledge about the clinical picture, laboratory findings and physical history of neoplastic liver-metastasis-induced FHF.     

Leptospirosis: report of a fulminant fatal case and review

In relation to the explosive increase of new and reemerging infectious diseases that threaten the humanity, and as a result of this clinical case, a literature review is done on Leptospirosis stressing out the necessity of having in mind the leptospirosis in the differential diagnostic for fever and jaundice syndrome.