RESUMEN
Pancreatic adenocarcinoma is a malignant and aggressive disease, whose diagnose is achieved in many cases at advanced stage. We present the case of a 63-year-old woman diagnosed with adenocarcinoma of the pancreatic head and body, which invaded hepatic artery and presented with portal vein thrombosis. She consulted for melena and upper endoscopy showed varicose lesions in the second part of duodenum. The patient developed acute worsening of anemia with hemodynamic inestability. Urgent contrast enhanced computed tomography revealed a massive hepatic necrosis without identification of the hepatic artery. Massive hepatic necrosis is an infrequent clinical condition described in bibliography after invasive procedures. The complete obstruction of the liver vascular system due to pancreatic cancer is an extremely unusual cause of massive liver necrosis.
Asunto(s)
Adenocarcinoma , Necrosis Hepática Masiva , Neoplasias Pancreáticas , Femenino , Humanos , Persona de Mediana Edad , Adenocarcinoma/complicaciones , Adenocarcinoma/diagnóstico por imagen , Adenocarcinoma/patología , Necrosis Hepática Masiva/complicaciones , Neoplasias Pancreáticas/complicaciones , Neoplasias Pancreáticas/diagnóstico por imagen , Neoplasias Pancreáticas/patología , Vena Porta/diagnóstico por imagen , Necrosis/patologíaRESUMEN
BACKGROUND AND AIMS: Autoimmune hepatitis (AIH) is a rare indication (<5%) for liver transplantation (LT). The aim of this study was to describe the early outcome after LT for AIH. METHODS: A multicenter retrospective nationwide study including all patients aged ≥16 transplanted for AIH in France was conducted. Occurrences of biliary and vascular complications, rejection, sepsis, retransplantation and death were collected during the first year after LT. RESULTS: A total of 344 patients (78.8% of women, 17.0% of (sub)fulminant hepatitis and 19.2% of chronic liver diseases transplanted in the context of acute-on-chronic liver failure [ACLF]) were included, with a median age at LT of 43.6 years. Acute rejection, sepsis, biliary and vascular complications occurred in respectively 23.5%, 44.2%, 25.3% and 17.4% of patients during the first year after LT. One-year graft and patient survivals were 84.3% and 88.0% respectively. The main cause of early death was sepsis. Pre-LT immunosuppression was not associated with an increased risk for early infections or surgical complications. Significant risk factors for septic events were LT in the context of (sub)fulminant hepatitis or ACLF, acute kidney injury at the time of LT (AKI) and occurrence of biliary complications after LT. AKI was the only independent factor associated with graft (HR = 2.5; 95% CI: 1.1-5.4; p = .02) and patient survivals (HR = 2.6; 95% CI: 1.0-6.5; p = .04). CONCLUSION: Early prognosis is good after LT for AIH and is not impacted by pre-LT immunosuppression but by the presence of AKI at the time of LT.
Asunto(s)
Hepatitis Autoinmune , Trasplante de Hígado , Necrosis Hepática Masiva , Sepsis , Humanos , Femenino , Adulto , Trasplante de Hígado/efectos adversos , Hepatitis Autoinmune/complicaciones , Hepatitis Autoinmune/cirugía , Necrosis Hepática Masiva/complicaciones , Estudios Retrospectivos , Sepsis/etiologíaRESUMEN
Wild mushroom grow abundantly in the tropical belts of India, and they form part of the diet among the ethnic tribes. However, wild mushrooms are toxic, and some cause organ failure, namely fulminant hepatitis and kidney injury. Mushroom poisoning is frequently diagnosed based on clinical suspicion, and death has been reported commonly because of the consumption of amatoxin-containing mushrooms. In this article, we discuss three cases of amatoxin-induced mushroom poisoning that resulted in acute kidney and liver failure, requiring intensive medical management and renal replacement therapy. One of these patients died from irreversible fulminant hepatitis.
Asunto(s)
Fallo Hepático , Necrosis Hepática Masiva , Intoxicación por Setas , Humanos , Intoxicación por Setas/complicaciones , Intoxicación por Setas/diagnóstico , Intoxicación por Setas/terapia , Necrosis Hepática Masiva/complicaciones , IndiaAsunto(s)
COVID-19/complicaciones , Herpes Simple/complicaciones , Herpesvirus Humano 1/aislamiento & purificación , Necrosis Hepática Masiva/complicaciones , Viremia/complicaciones , Aciclovir/uso terapéutico , Antivirales/uso terapéutico , COVID-19/patología , COVID-19/terapia , Manejo de la Enfermedad , Herpes Simple/patología , Herpes Simple/terapia , Herpesvirus Humano 1/efectos de los fármacos , Humanos , Unidades de Cuidados Intensivos , Masculino , Necrosis Hepática Masiva/patología , Necrosis Hepática Masiva/terapia , Persona de Mediana Edad , SARS-CoV-2/efectos de los fármacos , SARS-CoV-2/aislamiento & purificación , Índice de Severidad de la Enfermedad , Viremia/patología , Viremia/terapiaRESUMEN
TORCH (Toxoplasmosis, Rubella, Cytomegalovirus, Herpes Simplex Virus and Syphilis) infections are a major cause of intrauterine and perinatal infections with associated morbidity and mortality. Neonatal Herpes Simplex Virus infection caused by an enveloped, double-stranded DNA virus of the Herpesviridae family is devastating and fatal. Herpes Viruses are not hepatotropic but may rarely cause hepatitis. Most cases of HSV hepatitis rapidly progress to fulminant hepatic failure and often fatal before the diagnosis or transplantation. Nowadays, despite the availability of antiviral treatment (acyclovir), the outcome remains poor because of late identification of hepatic Herpes Simplex Virus (HSV) infection. We report a male neonate suspected with a metabolic/mitochondrial disease and multi-organ involvement but who developed a fulminant hepatic failure and disseminated coagulopathy secondary to HSV type 1 (HSV-1) infection. The postmortem diagnosis was performed demonstrating HSV-1 in liver tissue by transmission electron microscopy and by retrospective detection of HSV specific antigens by immunohistochemistry.
Asunto(s)
Herpes Simple , Herpesvirus Humano 1 , Fallo Hepático Agudo , Necrosis Hepática Masiva , Femenino , Herpes Simple/complicaciones , Herpes Simple/diagnóstico , Herpes Simple/tratamiento farmacológico , Humanos , Recién Nacido , Fallo Hepático Agudo/diagnóstico , Fallo Hepático Agudo/etiología , Masculino , Necrosis Hepática Masiva/complicaciones , Embarazo , Complicaciones Infecciosas del Embarazo , Estudios RetrospectivosRESUMEN
Background: Everolimus, an immunosuppressant, is approved for the treatment of advanced renal cell carcinoma, metastatic hormone receptor-positive breast cancer, and pancreatic neuroendocrine tumors (P-NETs) but has been reported to be related to hepatitis B reactivation. Here, we present the first case of fatal fulminant hepatitis B reactivation in a man with P-NET accompanied by multiple liver metastases who received everolimus and octreotide long-acting repeatable (LAR). Case Presentation: A 45-year-old male had a history of chronic hepatitis B infection. He was found to have a complicated liver cyst incidentally, and then he underwent biopsy, which disclosed a grade 2 neuroendocrine tumor (NET). Subsequent MRI of the abdomen and PET revealed a solid mass at the pancreatic tail with numerous liver tumors favoring metastases and peripancreatic lymph node metastases. Transarterial chemoembolization (TACE) of the right lobe of the liver was performed, and he started to take 5 mg everolimus twice a day and 20 mg octreotide LAR every month 8 days after the 1st TACE. No hepatitis B virus (HBV) prophylaxis treatment was administered. He then underwent laparoscopic distal pancreatectomy and splenectomy three and half months after the initial treatment of everolimus. He continued everolimus 5 mg twice a day and octreotide 20 mg every month after the operation. Three months later, hepatic failure occurred due to acute hepatitis B flare-up-related fulminant hepatic failure since other possible causes of hepatic failure were excluded. Five days after hepatic failure presented, hepatic failure was apparent, and pulseless ventricular tachycardia occurred. The patient expired after failed resuscitation. Conclusion: A literature review of everolimus-related hepatitis B reactivation was conducted. In P-NET patients with chronic hepatitis B who will undergo everolimus treatment, HBV prophylaxis should be considered since fatal hepatitis B reactivation might occur under rare conditions.
Asunto(s)
Everolimus/farmacología , Neoplasias Hepáticas/secundario , Necrosis Hepática Masiva/tratamiento farmacológico , Tumores Neuroendocrinos/tratamiento farmacológico , Neoplasias Pancreáticas/tratamiento farmacológico , Biopsia , Hepatitis B/complicaciones , Hepatitis B/mortalidad , Humanos , Neoplasias Hepáticas/complicaciones , Masculino , Necrosis Hepática Masiva/complicaciones , Necrosis Hepática Masiva/mortalidad , Persona de Mediana Edad , Tumores Neuroendocrinos/complicaciones , Octreótido/administración & dosificación , Neoplasias Pancreáticas/complicacionesRESUMEN
BACKGROUND & AIMS: Acute liver failure (ALF) is a life-threatening condition with limited treatment alternatives. ALF pathogenesis seemingly involves the complement system. However, no complement-targeted intervention has been clinically applied. In this study, we aimed to investigate the potential of Complement-5 (C5)-targeted ALF treatment. METHODS: ALF was induced in C5-knockout (KO, B10D2/oSn) mice and their wild-type (WT) counterparts (B10D2/nSn) through intraperitoneal lipopolysaccharide (LPS) and d-galactosamine (D-GalN) administration. Thereafter, monoclonal anti-C5 antibody (Ab) or control immunoglobulin was administered intravenously. Furthermore, a selective C5a-receptor (C5aR) antagonist was administered to WT mice to compare its efficacy with that of anti-C5-Ab-mediated total C5 inhibition. We clarified the therapeutic effect of delayed anti-C5-Ab administration after LPS/D-GalN challenge. We also assessed the efficacy of anti-C5-Ab in another ALF model, using concanavalin-A. RESULTS: Liver injury was evident 6 hours after LPS/D-GalN administration. C5-KO and anti-C5-Ab treatment significantly improved overall animal survival and significantly reduced serum transaminase and high-mobility group box-1 release with decreased histological tissue damage. This improvement was characterized by significantly reduced CD41+ platelet aggregation, maintained F4/80+ cells, and less infiltration of CD11+/Ly6-G+ cells with lower cytokine/chemokine expression. Furthermore, C5-KO and anti-C5-Ab downregulated tumor necrosis factor-α production by macrophages before inducing marked liver injury. Moreover, single-stranded-DNA cells and caspase activation were reduced, indicating significant attenuation of apoptosis. Anti-C5-Ab treatment protected the liver more effectively than the C5aR antagonist, and its delayed doses were hepatoprotective. In addition, anti-C5-Ab treatment was effective against concanavalin-A-induced ALF. CONCLUSIONS: C5 inhibition effectively suppresses progression to ALF in mice models of fulminant hepatitis, serving as a new potential treatment strategy for ALF.
Asunto(s)
Anticuerpos Monoclonales/farmacología , Complemento C5/antagonistas & inhibidores , Modelos Animales de Enfermedad , Fallo Hepático Agudo/prevención & control , Macrófagos/efectos de los fármacos , Necrosis Hepática Masiva/complicaciones , Animales , Apoptosis , Complemento C5/inmunología , Progresión de la Enfermedad , Fallo Hepático Agudo/etiología , Fallo Hepático Agudo/patología , Macrófagos/inmunología , Masculino , Ratones , Factor de Necrosis Tumoral alfa/metabolismoAsunto(s)
Infecciones por Coronavirus/epidemiología , Hepatitis Autoinmune/cirugía , Trasplante de Hígado , Necrosis Hepática Masiva/cirugía , Pandemias , Neumonía Viral/epidemiología , COVID-19 , Atención a la Salud , Urgencias Médicas , Femenino , Encefalopatía Hepática/etiología , Encefalopatía Hepática/cirugía , Hepatitis Autoinmune/complicaciones , Humanos , Necrosis Hepática Masiva/complicaciones , Persona de Mediana Edad , Programas Nacionales de Salud/organización & administración , Grupo de Atención al Paciente , España/epidemiología , Obtención de Tejidos y Órganos/organización & administraciónRESUMEN
Orlistat is an intestinal lipase inhibitor drug that is recommended in obese patients along with a hypocaloric diet. Although the most frequent secondary effect is steatorrhea, fulminant liver failure has also been associated with this drug, which has required liver transplantation in 3 patients. We present the case of a 42-year-old obese male.
Asunto(s)
Fármacos Antiobesidad/efectos adversos , Hígado Graso/tratamiento farmacológico , Fallo Hepático Agudo/inducido químicamente , Necrosis Hepática Masiva/complicaciones , Orlistat/efectos adversos , Adulto , Humanos , Masculino , Necrosis Hepática Masiva/inducido químicamente , Obesidad/tratamiento farmacológicoAsunto(s)
Colangitis/complicaciones , Fístula Intestinal/complicaciones , Necrosis Hepática Masiva/complicaciones , Isquemia Mesentérica/complicaciones , Sepsis/complicaciones , Antibacterianos/uso terapéutico , Antiinflamatorios no Esteroideos/efectos adversos , Colecistitis Aguda/tratamiento farmacológico , Tratamiento Conservador , Resultado Fatal , Hemorragia Gastrointestinal/inducido químicamente , Humanos , Masculino , Necrosis Hepática Masiva/diagnóstico por imagen , Melena/inducido químicamente , Persona de Mediana Edad , Vena Porta/diagnóstico por imagen , Úlcera Gástrica/inducido químicamente , Úlcera Gástrica/complicaciones , Tomografía Computarizada por Rayos XRESUMEN
We report the computed tomographic and angiographic findings in the case of a recently obtained successful clinical outcome after embolization of the hepatic artery in the case of a snakebite causing hemoperitoneum associated with hepatic necrosis and rupture with active bleeding.