Hépatite fulminante chez deux enfants traités par la salazopyrine pour une maladie de CrohnSalazopyrin-induced fulminant hepatitis in two children treated for. Request PDF on ResearchGate | Hépatite fulminante à virus Epstein-Barr: évolution favorable après transplantation hépatique | Viral hepatitis are the leading. Request PDF on ResearchGate | On Oct 1, , E. Mériglier and others published Hépatite fulminante fatale à virus de la varicelle-zona chez une patiente.
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In non-endemic countries, an increasing number of non-travel associated HEV has been reported in recent years, particularly in Europe. The authors describe the clinical case of a puerperal year-old woman from Pakistan admitted to our Tertiary Care Medical Center with acute hepatic failure developed during the third trimester of her pregnancy. She was icteric with grade III encephalopathy and hypothermia. Prothrombin time was prolonged 4 s and factor V activity was diminished Extracorporeal albumin dialysis was initiated, but clinical deterioration occurred within 48 h, so she underwent OLT at day 4 post-admission.
Severe forms of HEV fulmjnante known to be more pronounced in pregnant women. Even though most of the described cases of acute hepatic failure associated to HEV during pregnancy had a favorable clinical course, some cases of fulminant liver failure and death are described.
It is unknown whether liver transplant outcomes in this setting are different from other causes of acute liver failure. To our knowledge, this is the first case report in Portugal from a pregnant woman who developed hepatic failure due to fulminant hepatitis E that underwent successful liver transplantation.
Hepatitis Hepatihe is an inflammatory liver disease caused by hepatitis E virus HEV infection, which is a single-stranded, non-enveloped RNA virus and the only virus within the genus Hepevirus and the family Hepeviridae.
Testing for hepatitis E should be done in the diagnostic analysis of all patients with acute or chronic hepatitis that cannot be explained by other causes. Immunocompromised individuals should always be tested for HEV RNA, if there is suspicion that they are infected, because seroconversion can be delayed fulninante these patients.
Most infections have a clinically silent course. In symptomatic cases, the incubation period ranges from 2 to 8 weeks, with a mean of 40 days. However, more severe forms of acute liver disease can occur in pregnant women or patients with underlying chronic liver diseases, sometimes progressing to fulminant hepatic failure. In fact, in these individuals, acute hepatitis E does not usually require therapy. Persistent HEV infection was first reported in in 8 French solid organ transplant recipientes on immunosuppression.
Furthermore, one kidney-transplant patient had cirrhosis attributed to chronic HEV infection. A year-old puerperal woman was admitted to our Tertiary Care Medical Center with acute hepatic failure. She was a Pakistani woman living in Portugal for 3 years that had recently traveled to Pakistan while pregnant, for a total stay of 3 months.
She returned to Portugal during the third trimester of her pregnancy, 3 weeks before admission in our Hospital. During her time in Pakistan, she was observed by an Obstetrician and did a fetal ultrasound that she reported as being normal. Her background was unremarkable, she was married and mother of a 2-year-old healthy child, with a regular pregnancy and an heoatite delivery and a history of 2 previous spontaneous abortions.
She denied current medication and toxic or alcohol consumption. During pregnancy week 32, the patient reported nausea, vomiting, asthenia and myalgia. She went to an outpatient Obstetrics Consult in another Institution and in the same day was referred to the emergency room, because she also had jaundice. She did not recall what happened next. At that point, blood tests showed high liver enzymes transaminases aspartate transaminase ALT and alanine transaminase ALT and hyperbilirubinemia.
Labor was induced and she delivered a healthy female baby. During the next 12 h, she developed grade I encephalopathy, therefore being transferred to the ICU of our hospital. She was hypothermic Bilirubin was significantly elevated She had a normal platelet count. The head CT scan was normal and the abdominal ultrasound showed normal liver echogenicity without structural abnormalities, with patent, non-occluded liver vasculature.
PCR for Hepatitis E RNA was strongly positive, heparite she was diagnosed with acute hepatic failure heppatite by acute hepatitis E, with hepatic encephalopathy. She underwent OLT at day 4 post-admission.
Her explant had no major macroscopic alterations, except a slight softening of its consistency. The histological analysis revealed extensive areas of confluent panlobular, non-zonal necrosis, with porto-portal, porto-central and centro-central bridges. The residual parenchyma showed ballooned hepatocytes, marked pseudo-rosettes formation and cholestasis, either cytoplasmatic or in the center of the rosettes cholestatic rosettes.
Lobular inflammation with lymphocytes, plasmocytes, some neutrophils and numerous histiocytes were also detected Figs 12 e 3. Immediate graft function posttransplant was good and she had an unremarkable recovery. However, maximal similarity with more than one genotype was observed, meaning that this HEV could be a new genotype.
After 3 weeks at the neonatal ICU, she was transferred to the Pediatric Department, where she was released after 7 hepatihe. There is a complex interaction among viral, host, immunological and hormonal factors, producing a paradigma of severe liver damage in pregnancy. The maternal imune hepatote is clearly altered to tolerate a genetically diferente fetus.
There is a clear shift in the T-helper type 1 Th1: Th2 cell paradigm during pregnancy, with a definite skew toward Th2 cells.
Hepatites – Quadro de resumo
The levels of most cytokines are depressed, particularly during the initial 20 weeks of pregnancy. The genotype of this patient is not available yet, and even though there is some speculation regarding the influence of the genotype on clinical features in this setting, that remains to be proven.
Most of the described cases of acute hepatic failure associated to HEV during pregnancy had a favorable clinical course, but patients developing fulminant liver failure had a higher mortality rate.
Liver transplant is considered an option, but it is unknown whether its outcomes in this setting are different from other causes of acute liver failure. Furthermore, vertically transmitted HEV infection through fulmjnante blood is known to cause acute hepatitis in newborn babies. Studied 19 newborn babies born to HEV infected mothers and showed that Seven babies died in the first week after birth and all the surviving babies had self-limited disease, while none had prolonged viremia.
As the majority of cases are self-limited, liver biopsy is not usually performed, so the histology data about HEV acute hepatitis are scarce. However, several cases of acute HEV in the western world have recently been diagnosed with histological analysis. The latter leads to spotty or confluent necrosis, portal and lobular inflammation, ballooning degeneration of hepatocytes, intracytoplasmic and intracanalicular cholestasis and hepatocyte pseudo-rosette formation, in accordance with the features of our case.
Although not reaching statistical significance, ballooning, pseudo-rosette hepqtite, steatosis and plasma cells were more prevalent in HEV. The pseudorosettes a striking feature of our case are uncommon in the western cases and frequent in the cases in endemic areas.
The histological aspects of our case are similar to those found by Malcolm et al. As far as we know, this is the first case report in Portugal from a pregnant woman who developed hepatic failure due to fulminant fulmunante E that underwent a successful liver transplantation. Aggarwall R, Jameel S. The global burden of hepatitis E virus.
Hepatite E fulminante numa mulher grávida
Transmission routes and risk factors for autochtonous hepatitis E virus infection in Europe: Serologic assays specific to immunoglobulin M antibodies against hepatitis E virus: Hepatitis E virus infection as a cause of graft hepatitis in liver transplant recipients. A year singlecenter experience with acute liver failure during pregnancy: Ribavirin treatment for chronic hepatitis E: Pathogenesis and treatment of hepatitis E virus infection.
Hepatitis E in pregnancy. Int J Gynaecol Obstet.
Hepatitis E and pregnancy: Hepatitis E virus infection and fulminante hepatic failure during pregnancy. Does hepatitis E viral load and genotypes influence the final outcome of acute liver failure during pregnancy? Styrt B, Sugarman B. Severe hepatitis E infection during pregnancy. Outcome of hepatitis E virus infection in Indian pregnant woman admitted to a tertiary care hospital.
Maladie de Still de l’adulte compliquée d’une hépatite fulminante
Indian J Med Res. Khuroo MS, Kamill S. Aetiology, clinical course and outcome of sporadic acute viral hepatitis in pregnancy. Clinical presentation of hepatitis E. Clinical course and duration of viremia in vertically transmitted hepatitis E virus HEV infection in babies born to HEV-infected mothers. The histology of acute autochthonous hepatitis E virus infection.
Histological and immunohistochemical features in fatal acute fulminant hepatitis E. Indian J Pathol Microbiol. Liver histology in patients with sporadic acute hepatitis E: Protection of human and animal subjects. The authors declare that no experiments were performed on humans or animals for this study. The authors declare that they have followed the protocols of their work center on the publication of patient data and that all the patients included in the study received sufficient information and gave their written informed consent to participate in the study.
Right to privacy and informed consent. The authors declare that no patient data appear in this article. Conflicts of interest The authors have no conflicts of interest to declare. Received 17 October ; accepted 29 April Como citar este artigo.