Tu1549 – Skyrocketing Liver Enzymes: A Remarkable Case Presentation of Viral Myositis with Rhabdomyolysis

Abstract Background Hereditary multiple exostoses (HME) is a rare skeletal disorder characterised by a widespread. distribution of osteochondromas originating from the metaphyses of long bones. Case presentation This case study examines a 55-year-old male cadaver bequeathed to the University of Liverpool who suffered from HME, thus providing an exceptionally rare opportunity to examine the anatomical changes associated with this condition. Conclusions Findings from imaging and dissection indicated that this was a severe case of HME in terms of the quantity and distribution of the osteochondromas and the number of synostoses present. In addition, the existence of enchondromas and the appearance of gaps within the trabeculae of affected bones make this a remarkable case. This study provides a comprehensive overview of the morbidity of the disease as well as adding to the growing evidence that diseases concerning benign cartilaginous tumours may be part of a spectrum rather than distinct entities.

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An unusual case of multiple hepatic and pulmonary abscesses caused by Aggregatibacter aphrophilus in a young man: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-020-02650-z ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Johannes Sumer ◽

Sabine Haller ◽

Mikael Sawatzki ◽

Jan Kellner ◽

Katia Boggian

Keyword(s):

Unusual Case ◽

Liver Enzymes ◽

Hematogenous Spread ◽

Chain Reaction ◽

Case Presentation ◽

Doxycycline Treatment ◽

Aggregatibacter Aphrophilus ◽

Haemophilus Aphrophilus ◽

Polymerase Chain ◽

Diagnostic Importance

Abstract Background Aggregatibacter aphrophilus, formerly known as Haemophilus aphrophilus, belongs to the HACEK organisms, a group of pathogens classically associated with infectious endocarditis. A. aphrophilus is a rarely found pathogen, though abscess formation in various organs has been described, typically due to spread from an infected heart valve. Here we describe the unusual case of multiple hepatic abscesses caused by A. aphrophilus. Case presentation A 33-year-old Caucasian man presented at our hospital with fever and malaise, elevated inflammatory markers, and liver enzymes. Imaging was compatible with multiple liver and pulmonary abscesses, without evidence of endocarditis. Cultures of blood and liver abscess material remained without growth. Polymerase chain reaction finally revealed Aggregatibacter aphrophilus in the liver tissue. The patient recovered fully within 6 weeks of doxycycline treatment. Conclusions There are only a few case descriptions of liver abscesses caused by A. aphrophilus. As a ubiquitous organism in the gastrointestinal tract, A. aphrophilus may reach the liver via the portal venous system, as well as through hematogenous spread from the oropharynx. HACEK organisms are notoriously difficult to grow on culture, which highlights the diagnostic importance of eubacterial PCR.

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Trichrome-positive intrahepatic cytoplasmic globules are potential histopathological clue for COVID-19-induced hepatitis: a case report

Egyptian Liver Journal ◽

10.1186/s43066-021-00140-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Dina Sweed ◽

Mohamed Ramadan El Shanshory ◽

Eman Mohammed Elaskary ◽

Hassnaa Atef Hassan ◽

Enas Sweed ◽

...

Keyword(s):

Case Report ◽

Severe Acute Respiratory Syndrome ◽

Liver Biopsy ◽

Respiratory System ◽

Hepatitis A ◽

Liver Enzymes ◽

Dramatic Improvement ◽

Case Presentation ◽

Elevated Liver Enzymes ◽

History Of

Abstract Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection mainly affects respiratory system. Later, liver affection has also been reported in the form of marked elevated liver enzymes. However, the association of coronavirus disease-19 (COVID-19) and autoimmune diseases is not clear. Case presentation A female patient with a known history of autoimmune hemolytic anemia (AIHH) for which she was treated with prednisolone was admitted for uncontrolled anemia followed by fever and elevated liver enzymes. All the laboratory and radiological investigations were not typical for COVID-19 or any other etiology. Liver biopsy revealed numerous pale eosinophilic trichrome-positive intracytoplasmic globules. The pathology raised the suspicion for SARS-CoV-2-associated hepatitis, which was confirmed by a positive IgG titer. The patient showed a dramatic improvement on the maintenance dose of prednisolone. Conclusions AIHA patients co-infected with SARS-CoV-2 may be at risk of uncontrolled disease and should continue their treatment regimen. Histopathology has a role in the diagnosis of liver affection due to SARS-CoV-2 infection.

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Liver Bleeding Due to HELLP Syndrome Treated With Embolization and Liver Transplantation: A Case Report and Review of the Literature

Frontiers in Surgery ◽

10.3389/fsurg.2021.774702 ◽

2021 ◽

Vol 8 ◽

Author(s):

Valentina Messina ◽

Daniele Dondossola ◽

Maria Chiara Paleari ◽

Gianluca Fornoni ◽

Daniela Tubiolo ◽

...

Keyword(s):

Liver Transplantation ◽

Hellp Syndrome ◽

Multidisciplinary Approach ◽

Liver Enzymes ◽

Case Presentation ◽

Foetal Growth Restriction ◽

Elevated Liver Enzymes ◽

Life Threatening ◽

Low Platelet Count ◽

Liver Bleeding

Background: Liver bleeding secondary to haemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome is uncommon, but a life-threatening peripartum condition that needs a prompt multidisciplinary approach.Case Presentation: In this study, we presented a case of 28-year-old pregnant woman, who was presented to the obstetrics department with signs of preeclampsia and foetal growth restriction. An emergency caesarean section was performed, and the patient developed a HELLP syndrome complicated by spontaneous liver rupture. After radiological and surgical procedures, liver failure became evident and liver transplantation was successfully performed. The patient and her daughter are now alive.Conclusions: Despite the rarity of this disease, liver complications due to HELLP syndrome must be properly diagnosed and treated given the gravity of the possible evolution in young women. After diagnosis, the patients must be treated in specialised centres with gynaecological, liver surgery, and transplant skills.

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Reversible severe glycogenic hepatopathy in type 1 diabetes

Wiener Medizinische Wochenschrift ◽

10.1007/s10354-020-00795-6 ◽

2021 ◽

Author(s):

Jan de Laffolie ◽

Clemens Kamrath ◽

Diana Burchert ◽

Claudia Böttcher ◽

Stefan Alexander Wudy ◽

...

Keyword(s):

Type 1 Diabetes ◽

Liver Enzymes ◽

Insulin Pump ◽

Glycogen Storage ◽

Diabetic Patients ◽

Potential Complication ◽

Case Presentation ◽

Mauriac Syndrome ◽

Juvenile Diabetic

Summary Case presentation We report a case of severe glycogenic hepatopathy in a 17-year-old boy with poorly controlled type 1 diabetes. On presentation, major findings included unexplained pronounced hepatomegaly and increased liver enzymes, ferritin, and triglycerides. Histology and electron microscopy evaluation showed severe glycogen storage, steatosis, and signs of fibrosis, resembling the histomorphological findings of Mauriac syndrome. After information about the nature of the disease and intensification of insulin therapy with insulin pump, liver enzymes, ferritin, and triglycerides normalized within 1 month. Conclusion Glycogenic hepatopathy is a rare but important potential complication in poorly controlled juvenile diabetic patients. With improved metabolic control, it is fully reversible.

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Photoreceptor disk membrane substructures by means of the complementary freeze-fracture-replica methods

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100081644 ◽

1978 ◽

Vol 36 (2) ◽

pp. 156-157

Author(s):

A. Tonosaki ◽

M. Yamasaki ◽

H. Washioka ◽

J. Mizoguchi

Keyword(s):

Cell Membranes ◽

Freeze Fracture ◽

Purple Membrane ◽

Remarkable Case ◽

Single Face ◽

Disk Membrane ◽

Associated Proteins ◽

Photoreceptor Membranes

A vertebrate disk membrane is composed of 40 % lipids and 60 % proteins. Its fracture faces have been classed into the plasmic (PF) and exoplasmic faces (EF), complementary with each other, like those of most other types of cell membranes. The hypothesis assuming the PF particles as representing membrane-associated proteins has been challenged by serious questions if they in fact emerge from the crystalline formation or decoration effects during freezing and shadowing processes. This problem seems to be yet unanswered, despite the remarkable case of the purple membrane of Halobacterium, partly because most observations have been made on the replicas from a single face of specimen, and partly because, in the case of photoreceptor membranes, the conformation of a rhodopsin and its relatives remains yet uncertain. The former defect seems to be partially fulfilled with complementary replica methods.

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Hepatitis A Antigen in Liver, Bile and Stool

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100115328 ◽

1975 ◽

Vol 33 ◽

pp. 340-341

Author(s):

D.R. Jackson ◽

J.H. Hoofnagle ◽

A.N. Schulman ◽

J.L. Dienstag ◽

R.H. Purcell ◽

...

Keyword(s):

Hepatitis A ◽

Liver Enzymes ◽

Hepatitis A Virus ◽

Type A ◽

Initial Study ◽

Virus Like Particle ◽

Elevated Liver Enzymes ◽

Ag Particles ◽

Ag Particle ◽

Human Stool

Using immune electron microscopy Feinstone et. al. demonstrated the presence of a 27 nm virus-like particle in acute-phase stools of patients with viral hepatitis, type A, These hepatitis A antigen (HA Ag) particles were aggregated by convalescent serum from patients with type A hepatitis but not by pre-infection serum. Subsequently Dienstag et. al. and Maynard et. al. produced acute hepatitis in chimpanzees by inoculation with human stool containing HA Ag. During the early acute disease, virus like particles antigenically, morphologically and biophysically identical to the human HA Ag particle were found in chimpanzee stool. Recently Hilleman et. al. have described similar particles in liver and serum of marmosets infected with hepatitis A virus (HAV). We have investigated liver, bile and stool from chimpanzees and marmosets experimentally infected with HAV. In an initial study, a chimpanzee (no.785) inoculated with HA Ag-containing stool developed elevated liver enzymes 21 days after exposure.

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An adrenocortical oncocytoma with unusual mitochondrial inclusions and cytoplasmic crystals

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100168980 ◽

1994 ◽

Vol 52 ◽

pp. 250-251

Author(s):

W.T. Gunning ◽

G.D. Haselhuhn ◽

E.R. Phillips ◽

S.H. Selman

Keyword(s):

Adrenal Gland ◽

Salivary Glands ◽

Mitotic Activity ◽

Diagnostic Criteria ◽

Vascular Invasion ◽

Benign Neoplasm ◽

Benign Tumors ◽

Nuclear Morphology ◽

Case Presentation ◽

Microscopic Evidence

Within the last few years, adrenal cortical tumors with features concordant with the diagnostic criteria attributed to oncocytomas have been reported. To date, only nine reported cases exist in the literature. This report is the tenth case presentation of a presumptively benign neoplasm of the adrenal gland with a rare differentiation. Oncocytomas are well recognized benign tumors of the thyroid, parathyroid, and salivary glands and of the kidney. Other organs also give rise to these types of tumors, however with less frequency than the former sites. The characteristics generally used to classify a tumor as an oncocytoma include the following criteria: the tumor is 1) usually a solitary circumscribed mass with no gross nor microscopic evidence of metastasis (no tissue nor vascular invasion), 2) fairly bland in terms of mitotic activity and nuclear morphology, and 3) composed of large eosinophillic cells in which the cytoplasm is packed full of mitochondria (Figure 1).

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