ABSTRACT
We herein report a rather peculiar case of acute liver injury. A 78-year-old woman developed asthenia and weakness. Her previous medical history was irrelevant, except for having received etoricoxib 60 mg/24 h for osteoarthritis 1 month before. Liver biochemistry indicated hepatic failure; all tests for viral, bacterial, or parasitic infections were negative, as were the autoimmunity tests. As the patient's status gradually declined, a transjugular hepatic biopsy was obtained and confirmed hepatocyte necrosis with severe inflammation and presence of numerous eosinophils. Suspecting a potential toxic cause of the disorder, the patient was requestioned and admitted curcuma consumption for a long time. She was asked to discontinue it and her status gradually improved, with normalization of all the analytical parameters. On the long-term follow-up, she remains well. We consider that this case of acute liver injury can be explained with the combination of the acute toxic effect of a drug, etoricoxib, and the herbal remedy curcuma. This case is illustrative of the risk of interactions between drugs and natural remedies, and to the best of our knowledge, it is the first case of severe hepatotoxicity related to etoricoxib, probably potentiated by long-term curcumin intake. Besides, it illustrates the fact that patients do not generally consider natural remedies as potential source of toxicity, and this can lead to a delay in diagnosis.
ABSTRACT
BACKGROUND AND AIMS: Several cases of chronic infection by hepatitis E virus (HEV) in immunocompromised patients have been described recently. Patients with inflammatory bowel disease (IBD) are frequently immunocompromised because of the disease itself or due to therapy. Our aims were to determine HEV seroprevalence in patients with IBD and to detect possible chronic forms. Methods: We prospectively selected a random sample of 87 patients from our local IBD clinic database at the Gastroenterology Service, Hospital Ramón y Cajal, in Madrid, Spain. Patients completed an oral epidemiologic interview. Anti-HEV IgG and IgM antibodies and HEV-RNA were determined. Medical records were reviewed, focusing on drug exposure. Results: We included 87 patients, with a mean age of 44.7 years (SD 16) and a mean of 10.4 years (SD 8.4) with IBD. Fifty-seven percent were diagnosed with Crohn's disease, 41.4% with ulcerative colitis and 1.1% with unclassified IBD. A total of 41.4% had received systemic glucocorticoids for more than 3 months, 32.2% had been treated with thiopurines, 16.1% with biological drugs, and 3.4% with methotrexate. Anti HEV-IgM was determined in 75 patients and IgG in 80, and were positive in 2.7% and 1.3%, respectively. HEV-RNA was analyzed in a random subset of 46 patients, and all determinations were negative. Therefore, no case of chronic HEV infection was detected. Conclusions: We found a low HEV seroprevalence of just 1.14% in patients with IBD, similar to that in the general population. This could be due to the lower degree of immunosuppression in this group, or to different dietary habits
INTRODUCCIÓN Y OBJETIVOS: Recientemente se han descrito varios casos de infección crónica por el virus de la hepatitis E (VHE) en pacientes inmunodeprimidos. Los pacientes con enfermedad inflamatoria intestinal (EII) suelen estar inmunodeprimidos debido a la enfermedad en sí o debido a los tratamientos recibidos. Nuestro objetivo fue determinar la seroprevalencia de VHE en pacientes con EII y detectar posibles formas crónicas. MÉTODOS: Analizamos de forma retrospectiva una muestra aleatorea de 87 pacientes de nuestra base de datos de la consulta de EII en el Servicio de Gastroenterología del Hospital Ramón y Cajal, en Madrid, España. Los pacientes respondieron una encuesta epidemiológica oral y se determinaron anticuerpos IgG e IgM frente al VHE, así como RNA de VHE. Se revisaron las historias médicas, haciendo especial hincapié en los tratamientos recibidos. RESULTADOS: Incluimos 87 pacientes con una edad media de 44,7 años (D.E.16) y una media de 10,4 (D.E. 8,4) años de enfermedad. El 57% tenían una enfermedad de Crohn, 41,4% colitis ulcerosa y 1,1% colitis indeterminada. El 41,4% de ellos habían recibido corticoides sistémicos durante más de 3 meses, el 32,3% habían sido tratados con tiopurinas, el 16,1% con fármacos biológicos y el 3,4% con metotrexato. Se determinó la IgM frente a VHE en 75 pacientes y la IgG en 80, resultando positivos en 2,7% y 1,3% respectivamente. El RNA de VHE se analizó en un subgrupo aleatorio de 46 pacientes, y todas las determinaciones fueron negativas, así que no se detectó ningún caso de infección crónica por VHE. CONCLUSIONES: Encontramos una baja seroprevalencia de tan sólo 1,14% en los pacientes con EII, dato similar al de la población general. Esto podría explicarse por un menor grado de inmunosupresión en este grupo, o a diferentes hábitos dietéticos
Subject(s)
Humans , Hepatitis E/epidemiology , Inflammatory Bowel Diseases/complications , Seroepidemiologic Studies , Prospective Studies , Immunocompromised Host , Feeding Behavior , Risk FactorsABSTRACT
BACKGROUND AND AIMS: Several cases of chronic infection by hepatitis E virus (HEV) in immunocompromised patients have been described recently. Patients with inflammatory bowel disease (IBD) are frequently immunocompromised because of the disease itself or due to therapy. Our aims were to determine HEV seroprevalence in patients with IBD and to detect possible chronic forms. METHODS: We prospectively selected a random sample of 87 patients from our local IBD clinic database at the Gastroenterology Service, Hospital Ramón y Cajal, in Madrid, Spain. Patients completed an oral epidemiologic interview. Anti-HEV IgG and IgM antibodies and HEV-RNA were determined. Medical records were reviewed, focusing on drug exposure. RESULTS: We included 87 patients, with a mean age of 44.7 years (SD 16) and a mean of 10.4 years (SD 8.4) with IBD. Fifty-seven percent were diagnosed with Crohn's disease, 41.4% with ulcerative colitis and 1.1% with unclassified IBD. A total of 41.4% had received systemic glucocorticoids for more than 3 months, 32.2% had been treated with thiopurines, 16.1% with biological drugs, and 3.4% with methotrexate. Anti HEV-IgM was determined in 75 patients and IgG in 80, and were positive in 2.7% and 1.3%, respectively. HEV-RNA was analyzed in a random subset of 46 patients, and all determinations were negative. Therefore, no case of chronic HEV infection was detected. CONCLUSIONS: We found a low HEV seroprevalence of just 1.14% in patients with IBD, similar to that in the general population. This could be due to the lower degree of immunosuppression in this group, or to different dietary habits.
