Intrasinusoidal metastatic melanoma of the liver with reactive hepatitis. An immunologic phenomenon?

The macrophage migration inhibition factor (MIF) test toward extracts of choroidal melanoma was repeated four times in a patient with ocular malignant melanoma. In the initial stage, when there was only an ocular finding, the MIF test result was positive. It remained so for a period of two years, even when intrasinusoidal hepatic diffusion developed concomitantly with a nonspecific reactive hepatitis. These histologic findings can be interpreted as evidence of the presence of an immune reaction at a particular moment in the disease process. Several months later, when the patient's condition went into an abrupt decline and showed extensive nodular spread, the results of MIF test were found to have become negative.

Evaluation of prajmalium-induced cholestasis by immunologic tests.

Cholestatic jaundice developed in four patients after the administration of prajmalium bitartrate. The clinical, histologic, ultrastructural, and immunologic findings were determined. In all patients, the clinical and morphologic features indicated idiosyncrasy. Two antibodies distributed in a granular pattern along the bile canaliculi were detected by immunofluorescence in all patients. In one patient, autoimmune markers were found in the serum, and in two instances, the migration-inhibition factor assay against the offending drug was found to be positive. The data support the concept that immunologic processes may participate in the production of the cholestatic syndrome.

Use of tolonium chloride in the diagnosis of malignant gastric ulcers.

Peroral staining with tolonium chloride (toluidine blue) was performed in 45 patients with suspected gastric ulcer disease. During endoscopy, 19 of 21 malignant ulcers and one of 15 benign ulcers were stained. Following surgery, 18 of 21 malignant ulcers found in the surgical specimens were stained. Eleven patients with benign ulcers underwent surgery and none of these ulcers were found to be stained in the surgical specimens. Normal gastric mucosa and areas of gastritis appeared unchanged. The data suggest that tolonium chloride staining prior to endoscopy or surgery seems to be helful in differentiating between minute benign and malignant gastric ulcers.

Beneficial effect of colchicine in a case of sclerosing cholangitis.

A patient with ulcerative colitis and primary sclerosis cholangitis confirmed by liver biopsy and endoscopic retrograde cholangiography presented with severely altered liver function tests. A month of steroid treatment for the colitis symptoms had no effect on the liver function tests, and colchicine, 1 mg/day, was added. After 3 months of this combined treatment, improvement of the liver function tests was noted and progressed to complete normalization of all liver function tests at the end of a 2-year period of follow-up. On further follow-up, the patient remained asymptomatic and with normal liver function tests for an additional 3 years. Further controlled studies would be worthwhile to evaluate the possibility of treatment of primary sclerosis cholangitis with colchicine with or without steroids.

Hepatitis following cimetidine administration.

There have been only two reports of cimetidine-induced hepatitis. Such a low incidence suggests a hypersensitivity type of reaction. The case of an adult who developed both hepatic dysfunction and an impaired macrophage migration after exposure to cimetidine is discussed.

Case report. Immunological studies in a case of hepatitis following methyldopa administration.

Jaundice with evidence of hepatocellular damage of moderate severity was observed in a patient who received methyldopa. The diffuse mononuclear infiltration of the liver tissue was found to consist of 90% E-rosette-forming cells. Peripheral lymphocytes gave a markedly positive macrophage migration inhibition (MIF) test against methyldopa. The number of T lymphocytes in the peripheral blood was at the lower limit of normal but they proved to be functionally inactive, as demonstrated by the results of a local xenogeneic graft-vs-host reaction test. The liver disease was associated with hyperglobulinemia, a decrease of the third and fourth components of complement and the presence of incomplete erythrocytic antibodies, leukoagglutinins, antinuclear factor, and smooth muscle antibody. Follow-up after discontinuation of the drug revealed a gradual return to normal of liver function and MIF tests, normalization of cellular immunity, and disappearance of the humoral antibodies. It is assumed that sensitization by methyldopa triggered the autoaggressive phenomena and their ultimate manifestation in the liver.