Liver transplantation for acute liver failure related to autochthonous genotype 3 hepatitis E virus infection.

Hepatitis E virus of genotype 3 (HEV-3) is an emerging cause of sporadic autochthonous acute hepatitis in Europe. Although spontaneous outcome of hepatitis E is usually favorable, fulminant liver failure has been described worldwide. In Europe, autochthonous hepatitis E associated with fulminant hepatic failure and leading to liver transplantation has been exceptionally reported. We report here four cases of fulminant and sub-fulminant hepatitis E proposed for liver transplantation in Marseille University hospitals between July 2006 and March 2010. HEV diagnosis relied on detection of anti-HEV IgM antibodies and HEV RNA in serum samples. All cases were men, with no travel history in hyperendemic areas. HEV sequence analyses revealed genotype 3 HEV in the four patients. Liver histology indicated severe acute hepatitis in all of them, pre-existing fibrosis being found in two cases. Two patients underwent liver transplantation, and the two other patients could not be transplanted due to septic complications and died. HEV testing should be performed for the initial evaluation of every acute liver failure regardless of the epidemiological and clinical context. With respect to the potentially fulminant evolution of HEV genotype 3 infections, treatment with ribavirin of severe acute hepatitis E should be considered.

Intestinal obstruction due to a left paraduodenal hernia: a case report.

INTRODUCTION: A left paraduodenal hernia is a rare congenital malrotational anomaly of the midgut that occurs in the paraduodenal fossa of Landzert to the left of the fourth duodenum. It is responsible for approximately 1% of small bowel obstructions. CASE PRESENTATION: We report a case of left paraduodenal hernia combined with small bowel obstruction in a 47-year-old Mediterranean woman who had a history of recurrent abdominal pain. An abdominal computed tomography scan showed a saclike mass clustered in the left upper quadrant but failed to yield a clear diagnosis. We describe the surgical anatomy of this disease and the emergency surgical management together with a short review of the literature. CONCLUSIONS: Even though a left paraduodenal hernia is rare, it must be suspected in any upper intestinal occlusion. The high morbidity and mortality rate of complicated cases should motivate preventive treatment in case of incidental operative discovery.

Radiation induced esophageal adenocarcinoma in a woman previously treated for breast cancer and renal cell carcinoma.

BACKGROUND: Secondary radiation-induced cancers are rare but well-documented as long-term side effects of radiation in large populations of breast cancer survivors. Multiple neoplasms are rare. We report a case of esophageal adenocarcinoma in a patient treated previously for breast cancer and clear cell carcinoma of the kidney. CASE PRESENTATION: A 56 year-old non smoking woman, with no alcohol intake and no familial history of cancer; followed in the National Institute of Oncology of Rabat Morocco since 1999 for breast carcinoma, presented on consultation on January 2011 with dysphagia. Breast cancer was treated with modified radical mastectomy, 6 courses of chemotherapy based on CMF regimen and radiotherapy to breast, inner mammary chain and to pelvis as castration. Less than a year later, a renal right mass was discovered incidentally. Enlarged nephrectomy realized and showed renal cell carcinoma. A local and metastatic breast cancer recurrence occurred in 2007. Patient had 2 lines of chemotherapy and 2 lines of hormonotherapy with Letrozole and Tamoxifen assuring a stable disease. On January 2011, the patient presented dysphagia. Oesogastric endoscopy showed middle esophagus stenosing mass. Biopsy revealed adenocarcinoma. No evidence of metastasis was noticed on computed tomography and breast disease was controlled. Palliative brachytherapy to esophagus was delivered. Patient presented dysphagia due to progressive disease 4 months later. Jejunostomy was proposed but the patient refused any treatment. She died on July 2011. CONCLUSION: We present here a multiple neoplasm in a patient with no known family history of cancers. Esophageal carcinoma is most likely induced by radiation. However the presence of a third malignancy suggests the presence of genetic disorders.

Treatment of severe acute hepatitis E by ribavirin.

BACKGROUND: Acute hepatitis E is associated with a higher rate of mortality as compared to hepatitis A or B infections in some series. To date no treatment has been recommended for acute hepatitis E. However, ribavirin has been recently reported to be highly effective to treat solid-organ-transplant recipients chronically infected with hepatitis E virus (HEV). OBJECTIVE AND STUDY DESIGN: We report here on the use of ribavirin to treat severe acute HEV infection in a non-immunocompromized patient. This 61-year-old-man presented with acute hepatitis with HEV genotype 3. Seven days after admission, prothrombin index was 38%, bilirubinaemia was 550 µmol/L and alanine aminotransferases level was still increasing, reaching 4565IU/L. No hepatic encephalopathy was noted. Ribavirin (1200 mg/day) was introduced. RESULTS: Liver biological tests showed rapid improvement concurrently with a decrease in HEV RNA levels in serum samples. Therapy was interrupted after 21 days. At that time, ALT had normalized, bilirubinemia was 138 µmol/L, and HEV RNA was almost undetectable in the serum. CONCLUSION: Ribavirin therapy could be an effective treatment of severe acute hepatitis E.