[Impact of immunosuppressive treatment on liver fibrosis in autoimmune hepatitis]

Impact of treatment on progression of fibrosis in autoimmune hepatitis [AIH] is unknown. We assessed the changes in liver fibrosis before and after treatment among these patients. Nineteen AIH patients who had paired liver biopsies were studied. Of these, seven had been treated with 6 months of Cyclosporine-A and the rest with 6 months of prednisolone for induction of remission. Thereafter all had been maintained on azathioprine. Biopsy specimens before and after treatment, were reviewed by one pathologist and scored by the Ishak method. Mean fibrosis stage before and after treatment were compared. Also, factors predicting significant fibrosis [stage >/= 3] and cirrhosis [stage >/= 5] at presentation were assessed. Mean interval between biopsies was 3.38 years. Mean fibrosis stage decreased from 4.53 to 2.16 following treatment [p< 0.001]. Mean decrement in inflammatory grade was 8 scores [range: 4-10] in patients in whom fibrosis improved, and 2 scores [range: 0-4] in patients in whom fibrosis did not decrease after treatment [p< 0.001]. ALT to platelet ratio was the best predictor of significant fibrosis and also cirrhosis. Fibrosis commonly improves after immunosuppressive treatment in AIH. ALT to Platelet ratio can predict accurately the presence of significant fibrosis and cirrhosis in AIH

[Herpes simplex virus encephalitis during immunosuppressive treatment of ulcerative colitis]

Today, with the advent of new medications, treatment of Ulcerative colitis [UC] has been markedly improved. Immunosuppressive drugs used in therapy predispose patients to opportunistic infections. A 22-year-old woman was admitted to emergency department due to acute exacerbation of UC and decreased level of consciousness. She was under treatment with 5-aminosalicylate, prednisolone and azathioprine. In neurological evaluation, patient had cerebral herniation. Non-contrast CT scan revealed multiple hemorrhagic areas in both frontal lobes. Right frontal craniotomy was performed emergently. Histopathologic evaluation of brain tissue was reported as "Herpes simplex encephalitis". Polymerase chain reaction [PCR] assay was also positive for HSV DNA. Immunosuppressive drugs such as azathioprine have a pivotal role in the treatment of resistant and/or severe cases of UC. Prevalence of infectious complications was reported to be 7.4%, 1.8% of which were severe [including herpes zoster encephalitis] .Our review of literature indicates that no case of herpes simplex encephalitis following immunosuppressive therapy for UC has been reported