[The autoimmune hepatitis-primary biliary cirrhosis overlap syndrome: a case report]. / Síndrome overlap hepatitis autoinmune-cirrosis biliar primaria: a propósito de un caso.

The autoimmune hepatitis-primary biliary cirrhosis overlap syndrome is an entity characterized by clinical, analytical, immunological and histological manifestations of both entities. We present the case of a 26-year-old woman with a serious acute hepatitis that fulfills the diagnostic criteria of the overlap syndrome and that showed a satisfactory response to oral corticoid therapy.

[De novo hepatitis B with anti-HBc negative in a liver transplant recipient [corrected]]. / Hepatitis B de novo con anticuerpo frente al HBcAg negativo en un trasplantado hepático.

De novo hepatitis B was diagnosed in a 47-year-old man 15 months after liver transplantation for end-stage alcoholic cirrhosis. Serum antibodies to hepatitis B core antigen (anti-HBc) were negative, and remained undetectable over 20 months of follow-up. The possible causes of negative serum anti-HBc despite of active hepatitis B virus infection are reviewed. Immunosuppression may underlie this phenomenon in similar cases.

[Cocaine related fulminant liver failure]. / Fallo hepático fulminante asociado al uso de cocaína.

A 23-year-old woman developed biochemical signs of acute severe hepatitis together with confusion and flapping tremor after snorting a large dose of cocaine. Blood levels of cocaine were very high and liver biopsy performed few days later showed centrilobular necrosis. She recovered completely with conservative measures. Cocaine toxicity should be considered in similar cases of fulminant liver failure.

[Late-onset Wilsons disease]. / Enfermedad de Wilson de manifestación tardía.

A 58-year old male with a past history of psychiatric disorders was studied for a persistent serum transaminase increase. Low serum ceruloplasmin level (lower than 3 mg/dL), increased urinary copper excretion, and increased liver tissue copper concentration (1050 mcg/g dry weight) confirmed the diagnosis of Wilsons disease. Slit lamp examination did not show Kayser-Fleischer rings. D-penicilamin therapy was followed by serum transaminase normalization. Similar late-onset cases of Wilsons disease are exceptional, but confirm the clinical heterogeneity of the disease.

[Tuberculous peritonitis: a Third World's disease?]. / Peritonitis tuberculosa: ¿una enfermedad del tercer mundo?

Tuberculous peritonitis has a high morbidity and mortality. The clinical outcome of tuberculous peritonitis depends on an early diagnosis and treatment. We review five cases of tuberculous peritonitis diagnosed in a short stay medical unit over a one-year period. All patients were successfully treated with antituberculous drugs. The clinical management of this disease is described and current views regarding the value of computed tomography and other diagnostic techniques are discussed.

Isoniazid-induced hyperacute liver failure in a young patient receiving carbamazepine.

A 16-year-old female under long-term carbamazepine and clobazam therapy developed fulminant liver failure after initiating therapy with isoniazid, rifampin, and pirazinamide for intestinal tuberculosis. Liver failure was hyperacute (with a minimal interval between jaundice and encephalopathy) and occurred very shortly (5 days) after the start of antituberculous therapy. The patient recovered completely with conservative measures. Later, she tolerated carbamazepine, clobazam, rifampin, and pirazinamide without problems, thus confirming that liver failure was isoniazid-induced. Drug interaction between isoniazid and carbamazepine could explain the atypical presentation of this case.