Fulminant Hepatitis due to de novo Hepatitis B after Cord Blood Transplantation Rescued by Medical Treatment.

A 53-year-old man presented with fulminant hepatitis due to de novo hepatitis B. He had been diagnosed previously with adult T-cell leukemia (ATL) and previously resolved hepatitis B virus infection. The ATL had been treated with cord blood transplantation (CBT). He developed fulminant hepatitis 18 months after CBT, 15 months after the withdrawal of immunosuppressants, and 10 months after vitreous injections of methotrexate for ATL-related retinal infiltration. The aggressive medical protocol included entecavir, prednisolone, plasma exchange, hemodialysis, and bilirubin adsorption. We herein report successful medical treatment for fulminant de novo hepatitis B in a patient considered unsuitable for liver transplantation.

Hepatitis aguda fulminante por virus B durante el tratamiento del virus de la hepatitis C con antivirales de acción directa en paciente infectado con VIH / Acute fulminant hepatitis B during hepatitis C virus therapy with direct-acting antivirals in a patient co-infected with HIV

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Acute Hepatic Necrosis Caused by Salmonella enterica Serotype I 4,5,12:-:1,2 in a Dog.

Acute hepatic necrosis was diagnosed in a dog. Gram staining and fluorescence in situ hybridization identified Salmonella enterica in the liver, subsequently confirmed as S. enterica serotype I 4,5,12:-:1,2. This is the first report of acute hepatic necrosis with liver failure caused by Salmonella in a dog.

Intoxicação por Trema micrantha (Ulmaceae) em caprinos no Estado de Santa Catarina / Poisoning by Trema micrantha (Ulmaceae) in goats in the State of Santa Catarina

Vinte e cinco caprinos, criados em piquetes, morreram nos cinco dias subsequentes ao fornecimento de folhas de Trema micrantha (fam.Ulmaceae), uma árvore com nome comum de grandiúva. Quatro caprinos foram necropsiados e amostras de vísceras foram coletadas para exame histológico. As principais alterações clínicas foram: apatia, anorexia, cabeça apoiada contra obstáculos, decúbito e morte. Achados macroscópicos incluíram sufusões no epicárdio e endocárdio; fígado levemente amarelado e com padrão lobular evidente e, em um caso, acompanhado de hemorragias multifocais. Na histologia observou-se necrose hepática, que variava de centrolobular a massiva, compatível com hepatopatia tóxica. No SNC havia satelitose, tumefação neuronal, edema periaxonal, perivascular. O diagnóstico de intoxicação por Trema micrantha foi baseado no quadro clínico e lesional de hepatite tóxica associado ao uso da planta para alimentação de caprinos.

Twenty five goats, maintained in paddocks, had died in five subsequent days after have been offered leaves, mixed in the ration, of Trema micrantha, a tree commonly called grandiúva. Four animals were necropsied and samples were collected for histopathology. Clinical signs included apathy, anorexia, head pressing against obstacles, decubitus and death. Macroscopic findings included suffusions in the epi- and endocardium, a yellowish liver with pronounced lobular pattern, in one goat, the liver presented additionally multiple visible hemorrhages. Histological examination revealed centrilobular to massive hepatic necrosis consistent with acute liver toxicosis. In the brain, satelitosis, neuronal swelling, and perineuronal and perivascular edema was found. The diagnosis of poisoning by Trema micrantha was based in the clinical picture characteristic of toxic hepatitis associated in the feeding of the plant to the goats.

Achados clínicos e patológicos em cães infectados naturalmente por herpesvírus canino / Clinical and pathological Findings in dogs infected naturally by canine herpes virus

Descrevem-se os achados clínicos e patológicos e os exames laboratoriais de filhotes de cães com diagnóstico post mortem de infecção por herpesvírus canino. Os casos ocorreram em duas propriedades da Cidade de Porto Alegre, Rio Grande do Sul, em abril de 2007 e julho de 2008. Clinicamente, os cães apresentaram anorexia, apatia, choro e dispneia. A morte dos cães ocorreu após 24-72 horas do início dos sinais clínicos. Na necropsia observaram-se hemorragia multifocal renal e hepatomegalia com petéquias e pontos brancos na superfície natural do fígado. Os pulmões se apresentaram não-colapsados e vermelhos. Havia esplenomegalia e, em alguns cães, petéquias na superfície capsular do baço. Aumento dos linfonodos mesentéricos e do timo foi observado. Lesões microscópicas incluíram hemorragia e necrose multifocal em células epiteliais tubulares renais, hepatócitos e tecidos linfoides. Nos pulmões, havia necrose alveolar multifocal acentuada com abundante material fibrinoso e infiltrado inflamatório misto de intensidade variada. Ocasionais corpúsculos de inclusão intranucleares em áreas periféricas à necrose foram identificados em hepatócitos, células epiteliais de túbulos renais e células alveolares. Amostras de fígado, rim e pulmão foram positivas na imunofluorescência direta para herpesvírus canino tipo 1 (CHV-1). O diagnóstico de infecção por herpesvírus foi baseado nos achados de necropsia, histológicos e de imunofluorescência positiva em tecidos usando anticorpo anti-CHV-1. De nosso conhecimento, este é o primeiro relato da identificação do CHV-1 no Brasil, embora achados clínico-patológicos anteriores já sugerissem a presença do agente na população canina do país.

The clinic and pathological findings and laboratorial testing of puppies with postmortem diagnosis of canine herpesvirus infection are described. The cases occurred in two households of Porto Alegre, RS, in April 2007 and July 2008. The puppies presented anorexia, depression, cry and dyspnea, followed by death about 24-72 hours after the onset of clinical signs. At necropsy multifocal pin point hemorrhages were observed in the kidneys. The liver was enlarged with petechiae and white foci on the surface. The lungs were red and did not collapse. The spleen was enlarged and, in some cases, with petechiae on the capsular surface. Mesenteric lymph nodes and thymus were enlarged. Microscopic lesions included hemorrhages and multifocal necrosis of the renal tubular epithelial cells, hepatocytes and lymphoid tissues. In the lungs there was severe multifocal alveolar necrosis with abundant fibrin deposits and a mixed inflammatory infiltrate of variable intensity. Intranuclear inclusion bodies were identified in the periphery of necrotic areas in hepatocytes, renal tubular epithelial cells and alveolar cells. Samples of liver, kidney and lung were positive in the direct immunofluorescence test for canine herpes virus type 1 (CHV-1). The diagnosis was based on epidemiological data, necropsy findings, histological lesions and positive immunofluorescence results using CHV-1 antibody in tissue samples. To our knowledge, this is the first report of the identification of CHV-1 in Brazil, although previous clinic and pathological findings already suggested the presence of the virus in Brazilian canine population.

Special stains can distinguish hepatic necrosis with regenerative nodules from cirrhosis.

BACKGROUND: Focal zones of hepatic necrosis alternating with nodular regeneration in severe, acute to subacute hepatitis can be difficult to differentiate histologically from established cirrhosis, and diagnostic errors can result in incorrect patient management. Thus, an easily applicable, well-defined histologic method for differentiating these two lesions would be useful. METHODS: We examined trichrome (TRI), reticulin (RETIC), Verhoeff's elastic (VE), and orcein (ORC) stains on 13 cases of hepatic necrosis with regenerative nodules and 10 cases of end-stage cirrhosis to evaluate their utility for this problem. RESULTS: Zones of recent necrosis in all severe hepatitis cases stained paler blue or pink, respectively, with TRI and VE than the established scar in cirrhosis or residual normal portal zones/central vein walls. With VE and ORC, elastic fibres were not seen in the necrotic zones of severe hepatitis, but were present in all cirrhotic livers. RETIC outlined the residual cell plate architecture in necrotic areas but had indistinct staining in fibrotic areas. The combination of the RETIC, TRI and ORC distinguished hepatic necrosis with regenerative nodules from nodules in the scar of established cirrhosis in 100% of the cases examined. CONCLUSION: We conclude that this trio of special stains can be helpful adjuncts for this diagnostic problem.