Hepatitis alcohólica severa no respondedor a a glucocorticoides: reporte de un caso / Alcoholic hepatitis not responding to corticosteroids: a case report
Rev. ANACEM (Impresa)
; 7(2): 84-87, ago. 2013. tab
Article
in Es
| LILACS
| ID: lil-716563
Responsible library:
CL1.1
RESUMEN
INTRODUCCIÓN:
La hepatitis alcohólica corresponde a un daño inflamatorio agudo sobre un hígado progresivamente dañado por la ingesta excesiva y prolongada de alcohol. Puede presentar ictericia, manifestaciones de alcoholismo crónico e insuficiencia hepática progresiva. PRESENTACIÓN DEL CASO Varón de 60años con antecedentes de daño hepático crónico secundario a alcoholismo activo, que presentó cuadro de dos semanas de ictericia progresiva, prurito y bradipsiquia, asociado a leucocitosis, hiperbilirrubinemia, y elevación discreta de transaminasas, con predominio de GOT sobre GPT. Hemocultivos, urocultivo y serologías para virus hepatotropos fueron negativos. La ecografía abdominal mostró signos de hepatopatía crónica, sin dilatación de vía biliar. Con una función discriminante de Maddrey de 106 puntos se inició pentoxifilina, evolucionando tórpidamente. Se agregó prednisona durante siete días; se obtiene una puntuación de Lille de 0,99 (no respondedor), suspendiendo los corticoides. Progresó la insuficiencia hepática, con posterior insuficiencia renal aguda, acidosis metabólica, trastornos hidroelectrolíticos y fallecimiento al mes de evolución.DISCUSIÓN:
La hepatitis alcohólica posee alta mortalidad. Existen múltiples escalas pronósticas. Los corticoides están indicados en casos severos, sin embargo hasta un 40 por ciento se catalogan como no respondedores. Se requieren nuevos tratamientos para mejorar la supervivencia de estos pacientes.ABSTRACT
INTRODUCTION:
Alcoholic hepatitis constitutes an acute inflammatory episode due to prolonged alcohol abuse on a previously damaged liver. Clinical features include jaundice, signs of chronic alcoholism and progressive liver failure. CASE REPORT A 60-yearold male with a history of cirrhosis due to ongoing excessive intake of alcohol presented a two week history of progressive jaundice, pruritus, and bradypsychia. Laboratory tests showed leukocytosis, hyperbilirubinemia and a mild elevation of liver enzymes (GOT over GPT). Blood and urine cultures as well as serological markers for viral hepatitis were negative. Abdominal ultrasound showed signs of chronic liver disease, with no bile duct dilatation. A modified Maddreys discriminant function of 106 was determinant on starting therapy with pentoxifyline. However, patients status deteriorated. Prednisone was added to the treatment but seven days later, the patient was categorized as a non-responder (Lille score of 0.99), so the glucocorticoids were suspended. The patients liver failure progressed, after which renal failure, metabolic acidosis and electrolytic abnormalities developed; that led to his death after one month from admission.DISCUSSION:
Alcoholic hepatitis requires prompt diagnosis and treatment, due to its high death rate. There are various prognostic scales available, one of which is the modified Maddreys discriminant function. The fundamental therapeutic measure is the use of intravenous glucocorticoids; yet up to 40 percent of patients qualify as non-responders.Key words
Full text:
1
Collection:
01-internacional
Database:
LILACS
Main subject:
Hepatitis, Alcoholic
Type of study:
Etiology_studies
/
Prognostic_studies
Limits:
Humans
/
Male
Language:
Es
Journal:
Rev. ANACEM (Impresa)
Journal subject:
SAUDE PUBLICA
Year:
2013
Document type:
Article
Affiliation country:
Chile