A case of virus-associated hemophagocytic syndrome / 대한내과학회지

Hemophagocytosis refers to the pathologic finding of activated macrophages engulfing erythrocytes, leukocytes, platelets, and their precursor cells. Hemophagocytic syndrome (HS) (more properly referred to as hemophagocytic lymphohistiocytosis) is a distinct clinical entity characterized by fever, pancytopenia, splenomegaly, and hemophagocytosis in the bone marrow, spleen, and lymph nodes. HS is associated with a variety of viral, bacterial, fungal, and parasitic infections, as well as with collagen vascular diseases and malignancies. Epstein-Barr virus (EBV)-associated HS is almost always a fatal disease. The authors present a case of EBV-associated HS. The patient had fever and hepatosplenomegaly and showed pancytopenia, jaundice, and positive EBV viral markers in serum, positive EBV DNA in the liver biopsy specimen, and hemophagocytosis in the bone marrow. The patient died unexpectedly 1 month after admission. We report the details of this case of fatal EBV-associated hemophagocytic syndrome along with a brief review of the literature.

A Case of Hepatitis after Occupational Exposure of Trichloethylene / 대한간학회지

Trichloroethylene (TCE) is currently used as a degreasing agent in the jewelry manufacturing industry. The characteristic sign arising after the exposure of TCE are hepatitis and contact dermatitis. The incidence of toxicity is relatively rare, therefore, the mechanism of occurrence is considered as hypersensitivity. A previously healthy 21-year-old male began to work at jewelry industry. The solvent used in that place was TCE. Over the next month, he experienced symptoms of weakness, fever, dry skin, red rash and bumps, peeling face, and jaundice. At that time, he had marked liver enzyme elevation with evidence of cholestasis. After two weeks of avoidance of TCE exposure, his liver enzymes showed a marked reduction in ALT from a peak of 1132 to 131 IU/L. The total bilirubin reduced from 9.3 to 4.6 mg/dL. Tests for hepatitis A, B, and C, CMV, HIV were all negative. The patch test showed primary irritant reaction to TCE and its metabolite, trichloroethanol. This is the second report of TCE induced hepatotoxicity in Korea. We consider this case as a TCE induced hepatotoxicity due to possibly hypersensitivity mechanism.