慢性乙型肝炎临床治愈1例报告

正1病例资料患者男性,51岁,因间断乏力8个月余,面黄、目黄、尿黄10 d于2015年1月5日入院。既往史:1年前曾有献血史,否认病毒性肝炎病史及家族史,否认吸烟史,偶有少量饮酒,无特殊用药史。查体:血压120/72 mm Hg,一般状态尚可,面色晦暗,皮肤、巩膜重度黄染,浅表淋巴结未触及肿大,无肝掌、蜘蛛痣,腹部平坦,未见腹壁静脉曲张,无压痛、反跳痛、肌紧张,肝、     

Multiple primary liver lipomas in a patient with chronic hepatitis B: a case report

True liver lipomas are extremely rare. We present a case of a female patient with a history of chronic hepatitis B and multiple liver lipomas. The patient was completely asymptomatic. Liver ultrasound was suggestive of lipomas, whereas the diagnosis was confirmed by computed tomography and magnetic resonance imaging. To our knowledge, this is the first report of multiple liver lipomas in the literature.     

A resected case of fibrolamellar hepatocellular carcinoma with chronic hepatitis (type B)]

We report a case of a 34-year-old woman who tested positive for HBs Ag with fibrolamellar hepatocellular carcinoma of the liver. The sister of this patient, who was also positive for HBs Ag, died of hepatocellular carcinoma (HCC). The patient showed elevation of alpha-fetoprotein. Abdominal CT scan showed a tumor in the posterior segment of the liver and hepatic angiography revealed marked neovascularity in the tumor. Partial resection of the liver was performed, and the histological diagnosis was fibrolamellar hepatocellular carcinoma. The patient is now tumor free and doing well 20 months after the operation.     

Hepatocellular carcinoma in noncirrhotic young adult patients with chronic hepatitis B viral infection

Background The aims of this study were to define the clinical characteristics of hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) in young adult patients without cirrhosis and to evaluate the efficacy of interferon (IFN) therapy on HCC recurrence.Methods Of 187 patients with HBV-related HCC treated at our hospital, 4 had no liver cirrhosis and were less than 30 years of age (10, 22, 23, and 26 years).Results At the time of diagnosis of HCC, all cases had antibody to hepatitis B e antigen (anti-HBe) and histological staging of nontumorous liver was F0 or F1, i.e., low-grade hepatitis. The mothers of all 4 young adult patients with HCC had HBV-related liver disease. Three cases developed recurrence of HCC. In these patients, long-term intermittent IFN therapy after reresection of HCC resulted in long-term survival without recurrence for more than 3 years of follow-up.Conclusions (1) Young adult patients with HCC are positive for anti-HBe, lack cirrhosis, and the route of infection seems to be mother-to-infant transmission. Transplacental transmission of HBV and HBV DNA integration into the cellular genomic DNA during fetal life is a possible explanation of HBV-related hepatocarcinogenesis in young adults; and (2) long-term IFN therapy seems to be useful for prevention of tumor recurrence after radical operation for HBV-related HCC.     

Mucous membrane pemphigoid in a patient with chronic hepatitis B virus infection: A case report

Rationale:Mucous membrane pemphigoid (MMP) is a rare, autoimmune bullous disease that affects mucosal surfaces and skin. Early and aggressive treatment initiation may be warranted due to the risks of serious complications. However, it can be challenging to make an initial diagnosis. Viral infection such as hepatitis B virus (HBV) infection has been found to be associated with the formation of autoimmune bullous diseases.Patient concerns:The patient was a 43-year-old male with gingivitis and recurrent swelling over the neck, cheeks, lips, and eyelids. The patient presented at oral medicine, otolaryngology, plastic surgery, and ophthalmology sequentially, and was later referred to the rheumatology, dermatology, and family medicine departments. Recurrent hemorrhagic bullae on oral mucosa and skin scarring occurred 2 years after the onset of the initial symptoms.Diagnosis:Skin biopsy with direct immunofluorescence was performed under the suspicion of MMP. Lesional hematoxylin and eosin stain and perilesional direct immunofluorescence were consistent with MMP.Interventions:Systemic Prednisolone and topical corticosteroid were used to control the disease.Outcomes:A flare-up of hepatitis B developed as a result of systemic prednisolone use. The disease went through relapses and remissions. The patient is on low-dose prednisolone (5 mg/day) with a monthly outpatient visit in the family medicine department.Lessons:It would be useful for medical practitioners in different specialties to be alert of the heterogeneous presentations of MMP. Chronic HBV infection might be a risk factor for MMP. In patients with chronic HBV infection, treatment of MMP must be closely monitored for the risk of reactivation of HBV.     

成人慢性乙型肝炎合并急性淋巴细胞白血病1例报告

<正>机体对HBV特异性细胞免疫反应的活力、多样性及效应功能是HBV感染后转归的关键,因此,HBV在体内持续存在及复制是引起机体免疫功能紊乱和肝炎慢性化的主要原因。近年来,有关乙型肝炎并发血液病的报道逐渐增多,现将临床工作中遇到的1例成人慢性乙型肝炎合并急性淋巴细胞白血病(acute lymphoblastic leukemia,ALL)的病例报告如下。1临床资料患者男性,46岁,因"反复腹胀、乏力、纳差1年,加重1个     

乙型肝炎合并阵发性睡眠性血红蛋白尿1例报道

此病例为慢性乙型肝炎患者,抗病毒治疗中出现贫血、酱油色尿,确诊阵发性睡眠性血红蛋白尿,糖皮质激素治疗,疗效不理想。建议临床工作者应关注此类疾病的发生,早诊断、早治疗,同时通过对相关文献的复习,来探讨乙型肝炎合并阵发性睡眠性血红蛋白尿的治疗方法。     

Pegylated interferon alfa-2B induced lupus in a patient with chronic hepatitis B virus infection: case report

Drug-induced lupus is defined as a lupus-like syndrome temporally related to continuous drug exposure which resolves after discontinuation of the offending drug. Newer biological agents such as interferons (IFN) and anti-tumor necrosis factor-α therapies have been involved in the induction of lupus-like syndromes. Prompt recognition and discontinuation of the suspected drug are associated with excellent outcomes in most cases. In this article, we present the case who developed lupus during therapy with pegylated-IFN α-2b for chronic hepatitis B virus infection after 8 months.     

替比夫定致慢性乙型肝炎患者粒细胞减少1例报告

1病例资料患者男性,36岁,汉族,已婚,河北省行唐县人,工人。主因发现HBs Ag阳性10余年,肝功能异常1周于2012年2月17日就诊。患者10余年前体检时发现HBs Ag阳性,无乏力、纳差等不适,且肝功能正常,未予治疗。此后定期检查,未发现肝功能损害。1周前体检时发现肝功能异常:ALT 358 U/L、AST 163 U/L、TBil 26.3μmol/L、DBil 11.9μmol/L、GGT 133.2     

肝性血卟啉病合并病毒性肝炎1例

患者男,33岁,因反复腹痛,黄疸15 d入院。患者于2005年9月20日渐起腹痛,腹痛为脐周持续性隐痛,阵发性加重,皮肤巩膜逐渐黄染。当地医院查HBsAg阳性,ALT 358 U/L,AST、184 U/L,TBil 383μmol/L,直接胆红素(DBil)168μmol/L,PTA 51%,血清淀粉酶(AMS)正常,腹部B超未发现异常。10月2日行腹部平片示左腹部及右下腹肠管扩张积气并小液平面形成,疑患有肠梗阻给予胃肠减压及石蜡油口服,次日大便通畅。10月4日复查腹部平片示肠管积气减少,液平消失,无肠管扩张,但患者腹痛无好转,于10月5日转入我院。患者既往有CHB病史,1995年曾出现肝功能异常。皮肤有强光过敏病史并有家族史,病前1个月因接触电焊光致双手皮肤溃烂。     

慢性乙型肝炎患者应用阿德福韦酯出现肾损害1例分析

1 病例资料患者男性,33岁,主因发现肌酐升高3月余,尿检异常1周入院.自觉间断乏力、腰酸,1周前尿蛋白(++),尿蛋白定量3.6 g/d.无脱发、光过敏、颜面及下肢水肿;无游走性关节痛、关节畸形;无发热、盗汗、心悸、畏寒;无恶心呕吐、腹痛腹泻、尿频、尿急、尿痛.自觉尿泡沫增多,尿量、尿色未见明显变化,饮食睡眠良好,体重无明显变化.     

慢性乙型肝炎病毒合并丙型肝炎病毒感染伴2型糖尿病1例

一、病例资料 患者男性,63岁.广东湛江人,汉族,退休教师.因反复疲乏、纳差、尿黄15年余于2009年4月27日就诊.患者15年前无明显诱因出现疲乏,食欲不振,身目黄染、尿黄,曾到广东省人民医院就诊,检查发现肝功能异常,丙型肝炎抗体为阳性,诊断为"急性丙型肝炎",给予护肝治疗1月余,症状缓解.     

Amazing results with hydroxyurea therapy in chronic hepatitis B: a preliminary report

Background and Aims

To introduce the possible role of hydroxyurea (HU), a well-characterized antineoplastic drug with established antiviral effects, in the treatment of chronic hepatitis B.

Methods

Four antiretroviral-naïve patients with chronic hepatitis B were enrolled in this limited pilot trial, and given 1000 mg/day of hydroxyurea for 4 weeks; then, the administration of the drug was suspended for 4 weeks. A clinical study and laboratory safety assessments and measurements of viral load were made at baseline, after drug therapy, and after one month suspension of the treatment

Results

All 4 patients showed a significant decrease in viral load after 4 weeks of hydroxyurea therapy and the viral load of 2 patients increased again after a 4-week suspension of hydroxyurea

Conclusions

Our data demonstrate that the old low-cost antineoplastic drug, hydroxyurea, efficiently blocks hepatitis B virus (HBV) replication. We suggest that HU will play an important role in the treatment of chronic hepatitis in the fore- seeable future. Further studies including those that evaluate optimal dosing in long-term use will continue to define the role of HU in the treatment of HBV infection alone or in combination with other antiviral drugs     

Chronotropic incompetence in a young adult: case report and literature review

Chronotropic incompetence (CI) is the inability of heart rate response to meet metabolic demand. CI is associated with sinus node dysfunction, atrial fibrillation, or structural heart disease, and can lead to functional impairment. We report the case of a 34-year-old man with CI secondary to sinus node dysfunction who demonstrated significant improvement in functional capacity with rate-responsive pacing. Therapy for CI should be guided by the treatment of the underlying cause with consideration for rate-responsive pacing in symptomatic patients. The prognosis of CI is variable and dependent on underlying etiology.     

Axonal neuropathy and hearing loss associated with alpha interferon treatment in chronic hepatitis B: a case report.

The effect of interferon alpha in chronic viral hepatitis and common side effects are well known, but axonal polyneuropathy and hearing loss have been rarely reported. A 58-year-old woman was administered interferon alpha-2a (9 MU/3 times a week) and lamividin (100 mg daily) with the diagnosis of chronic hepatitis B. At the fifth month of the treatment gait disturbance and tinnitus developed. In her neurological examination tandem gait was ataxic on the right side. Cerebral magnetic resonance imaging performed to elucidate a probable cerebral pathology revealed nonspecific millimetric hyperintense lesions thought to be related with her hypertension anamnesis. Electroneuromyography demonstrated mild axonal polyneuropathy. The finding of pure-tone audiometry was sensorineural hearing loss in her left ear. Our diagnosis was axonal polyneuropathy and sensorineural type hearing loss as a side effect of interferon. In conclusion, the development of polyneuropathy and sensorineural hearing loss in the same patient may suggest autoimmunity as the cause of these side effects.     

Inherited protein C deficiency with acute ischemic stroke in a young adult: a case report

Hereditary protein C deficiency is inherited primarily as an autosomal dominant trait with incomplete penetrance. Arterial thrombosis, especially of the intracranial arteries, due to this deficiency is relatively rare. A 31-year-old man was admitted to our department because of sudden onset of neurological symptoms. Magnetic resonance imaging of the brain disclosed an acute ischemic infarction of the area supplied by the left middle cerebral artery. Protein C antigen was 40.7% (77-129%) and protein C activity was 46.3% (70-140%). No other possible associated causes of stroke were present. A survey of his relatives for protein C deficiency showed this deficiency in his mother, brother, sister and nephews. Protein C concentrations should be determined in cases of ischemic stroke in all young patients with no other major risk factors. Once protein C deficiency is detected, a search for protein C deficiency in the patient's relatives should be performed to prevent the occurrence of ischemic strokes.     

慢性丙型肝炎并发甲状腺功能亢进导致肝衰竭1例报告

正1病例资料患者女性,50岁,因抗-HCV阳性11个月,尿黄7 d于2015年6月3日入院。既往23年前行剖宫产手术,有输血史。患者2014年7月体检发现抗-HCV阳性,HCV RNA 5.2×106IU/ml,肝功能正常,甲状腺功能四项示促甲状腺激素(thyroid stimulating hormone,TSH)稍低,余正常。给予聚乙二醇干扰素(PEG-IFN)α-2b 80μg/周联合利巴韦林900 mg/d抗