Autoimmune hepatitis associated with the odour of fish food proteins: a causal relationship or just a mere association?

We present the case of a 15-year-old boy [HLA phenotype: A 1, 25 (10); B 18, 8; C 7; DR 17 (3), 6] with classic (type 1) autoimmune hepatitis presumably caused by a long-term exposure to the strong odour of food fed to a large number of tropical fish which that the boy kept in tanks in his bedroom. The boy presented with a history of recent symptoms of common cold, and a high cytomegalovirus-IgG titer, both known to activate proinflammatory cytokines. The patient's laboratory results and physical findings improved without specific treatment during his first stay in the hospital for several weeks, as well as when the thanks were removed from his bedroom while disease activity increased after his return home. This suggests that the association with fish food odour (putative volatile protein antigens) was not simply coincidental. Our patien's history is in agreement with the recently postulated pathomechanism of autoimmune hepatitis, according to which viral infections may trigger the disease in a genetically predisposed individuals persistently exposed to a constant antigenic stimulus, which results in ongoing allergic inflammation and finally develops into an immune process. The spontaneous remissions observed in our patient were characteristic of the natural course of autoimmune hepatitis and may reflect periods when he was not exposed to the eventually harmful effects of the odour of fish food proteins.

Autoimmune hepatitis associated with the odour of a fish food proteins: a causal relationship or just a mere association?

We present the case of a 15-year-old boy [HLA phenotype: A 1, 25 (10); B 18, 8; C 7; DR 17 (3), 6] with classic (type 1) autoimmune hepatitis presumably caused by a long-term exposure to the strong odour of food fed to a large number of tropical fish which that the boy kept in tanks in his bedroom. The boy presented with a history of recent symptoms of common cold, and a high cytomegalovirus-IgG titer, both known to activate proinflammatory cytokines. The patient's laboratory results and physical findings improved without specific treatment during his first stay in the hospital for several weeks, as well as when the thanks were removed from his bedroom while disease activity increased after his return home. This suggests that the association with fish food odour (putative volatile protein antigens) was not simply coincidental. Our patien's history is in agreement with the recently postulated pathomechanism of autoimmune hepatitis, according to which viral infections may trigger the disease in a genetically predisposed individuals persistently exposed to a constant antigenic stimulus, which results in ongoing allergic inflammation and finally develops into an immune process. The spontaneous remissions observed in our patient were characteristic of the natural course of autoimmune hepatitis and may reflect periods when he was not exposed to the eventually harmful effects of the odour of fish food proteins (AU)

Se presenta a un paciente de 15 años [fenotipo de HLA: A 1, 25 (10); B 18, 8; C 7; DR 17 (3), 6] con hepatitis autoimnune clásica (tipo 1) probablemente causada por la exposición a largo plazo al intenso olor de alimentos destinados a un gran número de peces tropicales que el chico guardaba en tanques en su dormitorio. Existían antecedentes de síntomas recientes de catarro y un título elevado de IgG por infección por citomegalovirus (IgG-CMV), factores ambos que activan citocinas proinflamatorias. La aparente mejoría de los resultados analíticos del paciente y de los hallazgos físicos sin tratamiento específico durante su primera estancia hospitalaria a lo largo de varias semanas (y también cuando se retiraron los tanques del dormitorio) podría indicar que la asociación de los síntomas al olor de una comida para peces (supuestos antígenos proteicos volátiles) no fue simplemente casual. La historia de nuestro paciente concuerda con el patomecanismo propuesto recientemente de hepatitis autoinmune en el que las infecciones virales pueden desencadenar la enfermedad en un paciente predispuesto genéticamente y expuesto de forma persistente a una estimulación antigénica constante que produce una inflamación alérgica progresiva que, finalmente, se desarrolla como un proceso inmunitario. Las remisiones espontáneas observadas en nuestro paciente eran características de la evolución natural de la hepatitis autoinmune y podría reflejar períodos en los que no estuvo expuesto a los posibles efectos perjudiciales del olor de las proteínas de los alimentos para peces (AU)

Autoimmune reactions in HBV and HCV.

BACKGROUND: Hepatotropic viruses HBV and HCV are capable of triggering autoimmune reactions (AIH). The aim of the study was the assessment of clinical course of AIH in patients with HBV and HCV, and the revision of treatment methods employed in these cases. MATERIAL AND METHODS: Among 120 patients with AIH and those qualified for antiviral therapy, 21 (17.5%) subjects were selected, including 16 with HCV (7 men and 9 women) and 5 with HBV (including 2 men and 3 women). AIH diagnosis was based on international criteria taking into account biochemical tests, autoantibodies and morphological picture of the liver. HBV infection was confirmed with the determination of HBV markers and HCV--with the presence of antiHCV and HCV RNA. RESULTS: The duration of infection at AIH diagnosis was difficult to assess in patients with HCV. AIH was diagnosed when patients were qualified for antiviral treatment. Three patients displayed high anti-LKM1, 8--ANA and SMA, two pts--ANA, two pts--SMA, one pt--ANA + pANCA and one--SMA + pANCA. Nine patients did not show hyperproteinaemia, and hypergammaglobulinaemia was not observed in 2 patients. Six patients suffered from other immunity disorders--thrombocytopenia, vasculitis, arthritis, visceral lupus erythematosus. The diagnosis of chronic hepatitis was confirmed by morphological examinations in 15 patients. Ten subjects received adrenocortical hormones, 3 patients were treated with adrenocortical hormones and azathioprine, 4 received interferon and 3 received no treatment. All patients with HBV proved HBeAg(-). In these patients, AIH symptoms developed 5-18 years after the diagnosis of HBV infection. Liver biopsy confirmed the diagnosis in 4 patients. SMA was observed in 2 subjects, ANA and SMA--in the remaining patients. All the subjects manifested typical biochemical changes as well as high IgG values. Extrahepatic exponents of immune process were observed in 3 patients. Three subjects were treated with Encorton (Prednisone), while 2 patients received Encorton and Azathioprine. CONCLUSIONS: Patients with HBV and HCV infections may manifest the features of AIH in the course of the disease, which requires careful attention while selecting treatment.

[Results of liver examination in drug addicts infected with HIV virus]. / Wyniki badan watroby u narkomanów zakazonych wirusem HIV.

Investigations included 52 drug-addicts with asymptomatic HIV virus infection. 8 of them suffered some years ago, from virus hepatitis of type B. Physical examinations did not reveal in examined persons any deviations from normal condition except for hepatomegaly. Results of liver biochemical investigations remained within normal limits. In each of them one confirmed presence of serological markers of HBV infection and in 35 of them of HCV and in 5 of them in parallel HDV. In all the examined persons one carried out liver biopsy and routine morphological examinations. In every case one disclosed a liver injury of drug-induced type. Further, in 31 examined persons one detected a coexistence of chronic, active inflammatory process of liver hepatitis minimal--17 hepatitis chronica persistent--12 hepatitis chronica aggressivE--1 cirrhosis hepatis--1 and in four of them changes of the type fibrosis periportal. In HIV infected drug-addicts it comes about to clinically asymptomatic, chronic hepatitis coexisting with morphological changes of drug-induced type liver.

[Detection of asymptomatic HBV infection among pregnant women based on personal studies]. / Bezobjawowe zakazenie HBV w populacji kobiet ciezarnych na podstawie wlasnych badan.

The total seroprevalence of HBsAg among pregnant women in Gdansk region is 1.3%. Our examination was based on observation of 226 HBsAg chronic carrier pregnant women. The risk of infection on the way of inoculation in childhood took place in 68%, in 10.8% it was connected with occupation. The presence of HBsAg and HBeAg was revealed in 8.8%. During period of observation none of the women eliminated HBsAg. The clinical course of infection in our group was stable. Liver biopsy was performed in 47 cases. Hepatitis minimalis was found in 35 cases, fibrosis portalis in 2, hepatitis chronica persistens in 5 and normal histological liver structure in 2 cases. Asymptomatic carrier state didn't influence on the course of pregnancy and delivery.

[Activity of gamma-glutamyltranspeptidase in clear cell carcinomas of the human kidney and renal cortex]. / Aktywnosc gamma-glutamylotranspeptydazy w jasnokomórkowych rakach nerki ludzkiej i w ich macierzystej korze nerkowej.

In 30 operated patients (23 men and 7 women) we determined the activity of GGTP in the tissue of renal clear-cell carcinomas and in their renal cortex. It was found that the enzyme activity was constantly lower in the tumours than in the spared kidney however with a correlation between the enhancement of GGTP activity in the renal cortex and clear-cell carcinomas originating in the tissue of the cortex. In contrast we did not observe a relation between the degree of morphological differentiation of the neoplasms and GGTP activity. The authors discuss the problem in the light of literature data.

Occurrence of ABO group antigens in bladder carcinoma.

Biopsies of bladder carcinoma obtained from 46 patients were tested for the presence of the group antigens, A, B and H. Lack of the antigens was confirmed in 69.6% of the samples examined. On the basis of histopathologic studies the patients were divided into three groups. The lack of the group antigens was reported in 86.4% bladder carcinoma patients; the lowest (45.5%) in the group of patients with papilloma of bladder. In cases of tumors with intermediate differentiation of tissue, the number of patients showing lack of group antigens amounted to 61.5%. Clinical observations carried out for five years suggest that the lack of group antigens is related to a recurrence of bladder carcinoma.

Mesangial proliferative glomerulonephritis in children.

Over a ten year period 105 children with a histological diagnosis of a mesangial proliferative glomerulonephritis were diagnosed. Patients were divided into two groups according to their clinical presentation at the time of diagnosis. Ninety two children presented with nephrotic syndrome (NS) of whom 82 received steroid therapy. No response was observed in 26 children and in 56 remissions were short in duration and subsequent relapses were frequent. Eighty nine children with the nephrotic syndrome were treated with cyclophosphamide (CP) of whom 26 had a steroid resistant NS, 53 were steroid dependent and 10 were previously untreated. Eighty four entered remission with a mean duration of 46 months. Only 5 children did not respond to treatment with CP. No correlation could be found between the results of therapy and the degree of morphological changes on examination of renal biopsy. The second group consisted of 13 children presenting with a persistent nephritic syndrome and or proteinuria. These children were untreated and no progression of renal disease was observed after several years follow up.