[Hepatosplenic cat-scratch disease in the immunocompetent adult]. / Malattia da graffio di gatto epatosplenica in adulto immunocompetente.

Atypical manifestations of cat-scratch disease have been described in children and immunosuppressed adults. We report the first case of hepatosplenic cat-scratch disease in an immunocompetent subject, demonstration of diversity of this infection. A 33-year-old man presented with prolonged fever, lymphadenopathy and multiple hypodense lesions of liver and spleen in ultrasonographic imaging. The hepatic biopsy showed non-specific inflammatory reactions including granulomata and stellate necrosis. Anti-Bartonella antibodies have been found. The therapy with clarithromycin and doxycycline for many weeks was effective for hepatic lesions. A month ago a history of a cat contact with the presence of a skin lesion has been reported.

[Occult gastrointestinal hemorrhage. Description of a case with unusual clinical presentation]. / Emorragie gastro-intestinali di origine sconosciuta. Descrizione di un caso con presentazione clinica anomala.

Bleeding from small bowel is a quite rare event and often is a diagnostic challenge to physician and surgeon. We present a case of a patient with an acute massive haemorrhage due to jejunal diverticulosis and with an unusual clinical setting. The site of bleeding was localized by scan with radiotagged erythrocytes, but the diagnosis of jejunal diverticule was evident only at laparotomy. The patient underwent to surgical resection of the affected bowel (40 cm). Although jejunal diverticula are considered a rare source of gastrointestinal haemorrhage, we suggest that this disorder must be considered in all patients with occult gastrointestinal bleeding especially in the elderly.

[Anti-GOR antibodies in type II mixed cryoglobulinemia associated with hepatitis C virus infection]. / Anticorpi anti-GOR nella crioglobulinemia mista tipo II associata a infezione da virus dell' epatite C.

The frequent association of chronic hepatitic C virus (HCV) infection and type II mixed cryoglobulinemia is considered to be one of the possible signs of interaction between the virus and the immune system. This could also be the case for the appearance of anti-GOR antibodies in serum, as they react with both viral and host antigens. We studied a group of patients with chronic hepatitis C infection and a group with type II mixed cryoglobulinemia associated with HCV infection to ascertain if anti-GOR or other non-organ specific autoantibodies were present in the serum. We found no significant difference between the two groups in presence, prevalence or titer of anti-GOR or other autoantibodies. Moreover, the expression of anti-GOR does not seem to influence the severity of liver damage. Our data support the hypothesis that anti-GOR antibodies are a simple expression of molecular mimicry between viral and human epitopes.

Hepatotoxicity of hydroxy-methyl-glutaryl-coenzyme A reductase inhibitors.

The first clinical studies on hydroxy-methyl-glutaryl-coenzyme A (HMG-CoA) reductase inhibitors reported a low incidence of liver toxicity. The personal observation of a case of simvastatin-induced acute cholestatic hepatitis prompted us to evaluate the true incidence of hepatic side effects of these drugs in a large Italian population. One hundred patients taking simvastatin and ninety patients treated with pravastatin were followed-up six months with periodical evaluation of serum lipid levels and liver function test. In 5% of simvastatin-treated patients and 4.5% of pravastatin-treated patients significant liver toxicity was observed, which required drug discontinuation. The mechanism of liver damage was direct, idiosyncratic, but immunological features of drug toxicity could be hypothesized in one patient.

Acute cholestatic hepatitis during simvastatin administration.

Simvastatin, recently introduced in clinical practice for pharmacological treatment of hypercholesterolemia, has been found to cause minor and reversible elevations of serum transaminases. We report a case of acute cholestatic hepatitis during simvastatin therapy. Clinical, biochemical, immunological, and histological findings were consistent with a simvastatin-induced liver damage through an immunological-mediated mechanism. This case suggests a careful monitoring of liver function tests during simvastatin therapy, and caution in continuing simvastatin administration when elevations of serum transaminases take place.