Can chronic hepatitis C resolve spontaneously? Case report and review

Chronic hepatitis C [CHC] is variably prevalent around the world and is usually a blood-borne infection. Most patients will have subclinical infection at the onset, but patients who develop acute hepatitis can spontaneously clear the virus upon immune activation. Up to 80% of CHC patients will progress to chronic infection. CHC is unlikely to clear spontaneously. This article describes two female patients with transfusion-acquired CHC diagnosed by both positive hepatitis C virus [HCV]-Ab and hepatitis C virus-polymerase chain reaction [HCV-PCR] tests. Both patients cleared the infection spontaneously after more than 5 and 25 years of CHC infection, respectively

Elevated serum immunoglobulin G levels in patients with chronic liver disease in comparison to patients with autoimmune hepatitis

Hypergammaglobulinemia is frequently observed in patients with chronic liver disease [CLD] of different causes. On the other hand, elevated levels of serum immunoglobulin G [IgG] are the best diagnostic marker for autoimmune hepatitis [AIH]. Thus, the ability to distinguish AIH patients from patients with other liver disease, especially patients with advanced liver cirrhosis, is important since most AIH patients will a have favorable treatment response if diagnosed properly. We conducted this study to evaluate the significance of elevated IgG levels in patients with nonautoimmune CLD and to compare these IgG levels with those in patients with AIH upon diagnosis. Setting and study population: The serum IgG levels in 27 patients with AIH determined at the time of diagnosis were compared to the serum IgG levels in 27 patients with other CLDs of variable severity at the King Abdul Aziz University Hospital in Jeddah, Saudi Arabia. Severity of the disease was evaluated in all patients. We found that the patients in the CLD group with decompensated cirrhosis had significantly higher serum IgG levels compared to the compensated CLD patients [p<0.02]. In addition, the AIH patients had significantly higher serum IgG levels than the non-autoimmune hepatitis CLD patients and the decompensated cirrhosis patients in the CLD group [p<0.001 and p<0.044, respectively]. Most patients with elevated serum IgG of the AIH group [67%] and the CLD group [75%] had significant hypergammaglobulinemia, not just isolated elevated IgG levels. Elevated serum IgG levels with hypergammaglobulinemia are commonly found in patients with advanced CLD. The differentiation of such cases from AIH is important in order to avoid misdiagnosis and confusion with AIH

Autoimmune hepatitis: single-center experience of clinical presentation, response to treatment and prognosis in Saudi Arabia

Autoimmune hepatitis [AIH] is a common cause of end-stage liver disease worldwide. It is a disease prevalent in children and adults, with female predominance and variable clinical presentations. AIH has favorable responses to steroids and immunomodulators. Diagnosis of AIH is based on clinical and laboratory criteria, as suggested by the International Autoimmune Hepatitis Group. Data on the disease pattern of AIH from the Middle East countries is scarce. In this retrospective analysis, we studied clinical and laboratory features, immunological data, radiological findings, liver biopsy findings and response to therapy in patients with AIH from the hepatology clinics of King Abdul Aziz, University Hospital, Jeddah, from 1994 to 2008. We diagnosed 41 patients with AIH, and 33 were included in the analysis. The mean age was 32.3 years, with female predominance of 75.7%. Decompensated cirrhosis at presentation was found in 45.5% of the patients. Acute hepatitis was associated with significantly higher levels of the serum ALT and bilirubin [P=0.001 and P=0.03, respectively]. All our patients had type 1 AIH. Treatment with prednisolone and azathioprine resulted in complete or partial remission in majority of the patients [54.8%]. However, patients with advanced disease showed a poorer response to treatment [P=0.016]. Six patients with poor compliance had relapse of AIH. Two patients had a flare of the disease during pregnancy, and they responded well with prednisolone. The longest follow-up was 14 years and the shortest was 2 months. Four patients died from liver disease. AIH patients in Saudi Arabia are likely to present with advanced disease at a young age and would have a poorer response to therapy as compared with patients in other countries worldwide

Pattern of admission to hospitals during muslim pilgrimage [Hajj]

The pattern of medical conditions necessitating admission differs according to the weather condition in that particular year. Previous studies had been conducted during the hot weather, none over the last 10 years, were carried out during, the milder weather we are experiencing. The aim of this study is to establish the pattern of admission during this mild weather and to elucidate the possible risk factors. A prospective study was performed in 4 hospitals in 2 different locations in Al-Mashaer, Kingdom of Saudi Arabia. Data were collected during one working shift in 2 hospitals in Arafat on the 9th of Dhul Hijjah 1422, corresponding to 21st of February 2002, and another working shift in 2 hospitals in Mina on the 10th of Dhul Hijjah 1422, corresponding to 22nd of February 2002. A cohort of 76 patients from Arafat hospitals and 84 patients from Mina' hospitals were included [total 160 Patients]. Males constituted 62% and females 38% with the median age of 60 ' 15years. The respiratory system was the most commonly affected [57%], followed by cardiovascular system [19.4%], and gastrointestinal tract [GIT] in 6.3% of cases. There were only 3 cases of heat-related admissions with only one confirmed case of heat stroke. Similarly, only one case of meningitis was confirmed in this cohort. Pneumonia was encountered in 63 cases [39.4%] and exacerbation of asthma and chronic obstructive pulmonary diseases [COPD] in 23 cases [14.4%]. Pre-existing co-morbid medical conditions had included bronchial asthma and COPD [22.5%], hypertension [17.5%], and Diabetes mellitus [15%]. Short-term follow up [24-48 hours] identified 2 deaths [1.3%], 94 patients [59%] were transferred to other secondary or tertiary care facilities and 64 [40%] were discharged home. Hospital admission during Hajj is related to old age and occurs in patients with associated co-morbid conditions. During this mild weather lower respiratory tract infections and exacerbation of bronchial asthma and COPD are the most commonly encountered diseases during Hajj

Effect of pegylated interferon on non responders and relapsers with interferon

To assess whether a combination of pegylated interferon [interferon conjugated with polyethylene glycol] and ribavirin can improve the response rate in patients with chronic hepatitis C who either did not respond to [Non-responders], or had relapsed after responding to [Relapsers] standard interferon and ribavirin combination therapy. In this prospective study, 20 chronic hepatitis C patients [comprising 16 Non-responders and 4 Relapsers to previous treatment with alpha interferon and ribavirin], were treated with pegylated interferon-2b weekly and ribavirin daily for one year. Eleven patients had genotype 4, eight were of genotype 1 and one patient had genotype 3. Response to treatment was determined based on normalisation of liver enzymes and negative viral load [assessed using qualitative HCV RNA PCR] at end of treatment [ETR] and 6 months off treatment [SVR]. Seven patients [35%] achieved normalisation of liver enzymes and negative viral load at the end of treatment. However, only 2 patients [10%] managed to retain these levels after six months off treatment. The latter two patients had been previous Relapsers. Combination of pegylated interferon and ribavirin may be beneficial in previous relapsers with standard interferon-ribavirin combination therapy, but is unlikely to achieve sustained virological response in non-responders

Chemoembolization in metastatic liver neoplasms: KAUH experience

To assess the results of chemoembolization in this pilot study for patients with unresectable metastatic liver neoplasms. Patients with unresectable liver metastases secondary to different primary tumors who did not have decompesated liver disease underwent selective intra-arterial chemotherapy consisting of 5-flourouracil, adriamycin and cisplatin followed by embolization of the feeding artery using Poly Vinyl Alcohol Particles [PVAP]. Courses of treatment were given every four to six weeks for a minimum of three courses. Eight patients with bilateral multiple or diffuse liver metastasis underwent chemoembolization. Five out of eight patients had good palliation of symptoms and improvement in their quality of life. Their average duration of palliation was 7.2 months. Median survival for all patients was seven months. Seven patients died within the first year from a diagnosis of liver metastasis. The last patient with carcinoid syndrome is still alive 36 months after diagnosis. Selective intra-arterial chemotherapy followed by embolization in this pilot study with unresectable liver metastases gives palliation of symptoms and improvement in the quality of life for almost half of our patients but for a short duration. Patients with neuroendocrine tumors may have longer duration of palliation and survival. Further randomized trials with a higher number of patients would be worthwhile pursuing