ABSTRACT
Objective To analyze the clinical and histological features of drug-induced autoimmune hepatitis (DI-AIH).Methods From January 2008 to June 2011,five patients with auto-immune hepatitis (AIH),having a definitive history of medicine taking prior to the onset of disease and accepted liver biopsy were retrospectively analyzed.The general information was collected,which included gender,age,onset of the disease,medication,clinical manifestations,treatment and follow-up.The laboratory findings were also collected,which included total bilirubin (TBil),direct bilirubin (DBil),alanine transaminase (ALT),aspartate transaminase (AST),alkaline phosphatase (ALP),gamma glutamyl transpeptidase (GGT),globulin,γ-globulin percentage,albumin (Alb),eosinophils,antinuclear antibodies,antimitochondrial antibodies,anti-smooth muscle antibodies and the type of live injury.The liver tissue sections of patients were stained with hematoxylin-eosinstaining (HE) and reticular fiber staining and then pathological changes were observed.Patients with DI-AIH were scored with AIH scoring scale.Results All five patients with DI-AIH were female,average age was 48.0--+7.5.Prior to the onset of disease,all patients had taken Chinese traditional medicine.Anorexia and fatigue were the most common clinical symptoms.Among laboratory findings,the level of ALT ((795.0+467.4) U/L),AST ((730.44-451.5) U/L),TBil ((80.3-+ 64.1) μmol/L) and DBil ((65.2 +_ 58.0) μmol/L) significantly increased.One patient was antinuclear antibody positive.One patient had drug-induced liver injury,pathological features were spotty necrosis of liver cells,liver tissue eosinophil infiltration and liver cell microbubble type degeneration.All the patients had interface hepatitis,periportal infiltration of lymphocytes or lymphocytes-plasma cells,liver cells adjacent to lesion showed rosette-like structure.All the patients received glucocorticoid treatment.After glucocorticoid withdrawal,the liver function was normal during the follow-up period.Conclusion There are no specificity of clinical manifestations,laboratory findings and histological features in patients with DI-AIH.
ABSTRACT
Background and purpose:In the primary cutaneous CD30 positive lymphoproliferative disorders, despite the common reports about the primary cutaneous anaplastic large cell lymphoma and lymphomatoid papulosis, such reports about the bordline disease-lymphomatoid papulosis (type C) were rare. This article was to introduce and discuss its clinical manifestations and morphological and immunophenotypic features. Methods:Based on the related literature, we reviewed the clinical,pathological and immunohistochemical features from one case presented in Huashan Hospital. Results:The patient, male, was 56 years old with systemic red papuloid skin lesions accompanied with pruritus, which were sporadic, chronic, recurrent and self-healing. The duration of the disease persisted more than 26 years. Recently, the multiple papuloid lesions developed to be agrias, ulcerations and black eschars. Histopathologically, besides the ulcerated epiderm exfoliation, there were medium and large atypical lymphocytes in? trating in dermis layer. These cells showed postive for CD30,TIA-1 and CD3, and negative for ALK and CD20. Conclusions:When diagnosing LyP (type C),a rare disease, we should differentiate it from the primary cutaneous anaplastic large cell lymphoma (C-ALCL) and systemic anaplastic large cell lymphoma involving the skin, and also combine the clinical and histopathological characteristics and immunophenotype to identify its defi nition and nature.