ABSTRACT
Fibrosing cholestatic hepatitis is an aggressive and usually fatal form of viral hepatitis in immunosuppressed patients. We report three cases of fibrosing cholestatic hepatitis in various clinical situations. Case 1 was a 50-year-old man who underwent a liver transplant for hepatitis B virus (HBV)-associated liver cirrhosis. Two and a half years after the transplant, he complained of fever and jaundice, and liver enzymes were slightly elevated. Serum HBsAg was positive. Case 2 was a 30-year-old man in an immunosuppressed state after chemotherapy for acute lymphoblastic leukemia. He was a HBV carrier. Liver enzymes and total bilirubin were markedly elevated. Case 3 was a 50-year-old man who underwent renal transplantation as a known HBV carrier. One year after the transplant, jaundice developed abruptly, but liver enzymes were not significantly elevated. Microscopically lobules were markedly disarrayed, showing ballooning degeneration of hepatocytes, prominent pericellular fibrosis, and marked canalicular or intracytoplasmic cholestasis. Portal inflammation was mild, but interphase activity was definite and cholangiolar proliferation was prominent. Hepatocytes were diffusely positive for HBsAg and HBcAg in various patterns. Patients died of liver failure within 1 to 3 months after liver biopsy in spite of anti-viral treatment.
Subject(s)
Adult , Humans , Male , Cholestasis, Intrahepatic/virology , Cholestasis, Intrahepatic/immunology , Cholestasis, Intrahepatic/etiology , Fibrosis , Hepatitis B/complications , Immunosuppression Therapy/adverse effects , Liver Transplantation , Middle AgedABSTRACT
There are few reports of hepatitis related to the Chinese Medicine in Korea. Because herbal medicine contains many ingredients, it is confused what ingredient causes the hepatitis. We experienced a case of acute hepatitis developed after consumption of Chinese herbal medicine, Ho-Shou-Wu, for 75 days which contains only one component, Polygonum multiflorum, in a 55 year-old woman. And gradual recovery from hepatitis was observed after stopping the medication. Drug-induced hepatitis was diagnosed with typical clinical course and exclusion of all the possible causes of acute hepatocellular injury. We report this case with review of literature.