scholarly journals Acute icteric hepatitis as the first isolated symptom of COVID-19

2021 ◽  
Vol 14 (6) ◽  
pp. e242853
Author(s):  
Pierre-Clément Thiebaud ◽  
Christelle Hermand ◽  
Jennifer Sobotka ◽  
Pierre-Alexis Raynal
Keyword(s):  
Liver Injury ◽  
Acute Hepatitis ◽  
Clinical Presentation ◽  
Liver Enzymes ◽  
Healthy Patient ◽  
Moderate Elevation

Patients with COVID-19 may be asymptomatic or present with extrarespiratory symptoms, such as liver injury. It has been reported that 22.5%–46.2% of patients have moderate elevation of liver enzymes. To our knowledge, acute hepatitis has never been described as an isolated symptom of COVID-19 in a previously healthy patient. We report the case of a 53-year-old patient with COVID-19 whose first clinical presentation was acute icteric hepatitis, several days before the development of others symptoms. During the pandemic, we suggest that patients with acute hepatitis be considered as COVID-19 suspects, tested and isolated.

scholarly journals Disulfiram-Induced Acute Liver Injury

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Lucas Ramer ◽  
Matthieu Tihy ◽  
Nicolas Goossens ◽  
Jean-Louis Frossard ◽  
Laura Rubbia-Brandt ◽  
...  
Keyword(s):  
Liver Injury ◽  
Acute Hepatitis ◽  
Fulminant Hepatitis ◽  
Liver Enzymes ◽  
Drug Withdrawal ◽  
Acute Liver Injury ◽  
True Incidence ◽  
Elevated Liver Enzymes ◽  
Severity Of Injury ◽  
Hepatocyte Necrosis

Disulfiram is a drug used to treat alcohol dependence since many years. It interferes with the metabolism of alcohol, may be associated with neurological and dermatological symptoms, and can be hepatotoxic. Due to the frequent coexistent liver test alterations due to alcohol, the true incidence of disulfiram-associated liver injury is unclear and severity of injury may vary from mildly elevated liver enzymes to fulminant hepatitis leading to death. There are several reported cases of disulfiram hepatitis in the literature. Liver histology, when available, demonstrates some degree of portal inflammation with eosinophils and hepatocyte necrosis. We present here a well-documented case of acute hepatitis due to disulfiram with typical histological lesions, favorable outcome following drug withdrawal, and a brief steroid course. The risk of hepatotoxicity should be kept in mind when prescribing disulfiram.

scholarly journals Amiodarone-Induced Acute Liver Injury

2020 ◽  
Vol 14 (1) ◽  
pp. 87-90
Author(s):  
Rajesh Essrani ◽  
Shehriyar Mehershahi ◽  
Rajesh Kumar Essrani ◽  
Shri Jai Kirshan Ravi ◽  
Sajeer Bhura ◽  
...  
Keyword(s):  
Liver Injury ◽  
Acute Hepatitis ◽  
Injection Site ◽  
Half Life ◽  
Thyroid Dysfunction ◽  
Liver Enzymes ◽  
Acute Liver Injury ◽  
Hepatic Toxicity ◽  
Intravenous Amiodarone

Amiodarone is a lipophilic structure with a half-life of 25–100 days. Long-term oral amiodarone is associated with photosensitivity, thyroid dysfunction, and pulmonary and hepatic toxicity. Intravenous amiodarone can lead to sweating, heating sensation, nausea, phlebitis at the injection site, and rarely acute hepatitis. This is a compelling case of a 60-year-old male who developed acute liver injury 24–36 h after starting amiodarone. All the possible causes of acute liver injury were ruled out, and his liver enzymes improved after discontinuing amiodarone.

scholarly journals Role of Liver Enzymes in Patients with Blunt Abdominal Trauma to Diagnose Liver Injury

2020 ◽  
Author(s):  
Anup Shrestha ◽  
Harish Chandra Neupane ◽  
Kishor Kumar Tamrakar ◽  
Abhishek Bhattarai ◽  
Gaurav Katwal
Keyword(s):  
Liver Injury ◽  
Confidence Interval ◽  
Ct Scan ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Predictive Value ◽  
Liver Enzymes ◽  
Tertiary Center ◽  
Significant Difference

Abstract Background:The liver is the second most injured organ following blunt abdominal trauma (BAT) after spleen. Although the computed tomography (CT) scan is considered as the gold standard for diagnosing liver injury in BAT, it is not readily available in the hospital. This study was performed to evaluate the role of aspartate transaminase (AST) and alanine transaminase (ALT) in patients with BAT and its significance in predicting the diagnosis and severity of the liver injury.Method:The study was conducted in Chitwan Medical College Teaching Hospital (CMCTH) study from February 2019 to May 2020. During that period 96 patients with BAT presented to the emergency department(ED) of CMCTH.Results:Among the 96 patients admitted with BAT, 38 patients had liver injury and 58 patients had no liver injury. The median length of the intensive care unit (ICU) stay of patients with liver injury was higher than without liver injury. There was a significant difference in the median level of AST and ALT (<0.001) between patients with liver injury and no liver injury. The area under the ROC curve of AST was 0.89(95% Confidence Interval 0.86-0.98) and of ALT was 0.92(95% Confidence Interval 0.83-0.97). The area under the curve demonstrated that the test was a good predictor for the identification of liver injury and also the severity of liver enzymes. The cut-off values for the liver injury were 106 U/l and 80 U/l for AST and ALT respectively. Based on these values, AST ≥ 106 U/l had a sensitivity of 71.7 %, a specificity of 90 %, a positive predictive value of 86.8 %, and a negative predictive value of 77.6 %. The corresponding values for ALT ≥ 80 U/l were 77.8 %, 94.1%, 92.1% and 82.8 %, respectively.ConclusionIn conclusion, we report the optimal cut-off value of AST and ALT for liver injury in BAT as ≥ 106 U/l and 80 U/l respectively. The elevated level of AST and ALT might assist the surgeons to timely refer the suspected patients with the liver to a tertiary center and it might help the surgeons to go for conservative management for minor liver injuries in BAT preventing the exposure hazards of the CT scan.

scholarly journals Hepatitis and Meningoencephalitis due to Enterovirus in a Toddler

2018 ◽  
Vol 3 (1) ◽  
pp. 43
Author(s):  
Mohammad Ali Raza Qizalbash ◽  
Rida Zahra ◽  
Adnan Adil Mithwani ◽  
Anwar Adil Mithwani ◽  
Muaaz Adil Mithwani
Keyword(s):  
Acute Hepatitis ◽  
Clinical Picture ◽  
Clinical Presentation ◽  
Viral Infections ◽  
Coxsackie Virus ◽  
Watery Diarrhea ◽  
Case Presentation

Background: Acute hepatitis caused by viral organisms which are typically implicated in the cases of encephalitis are rarely reported in literature. The presentation of enteroviral meningoencephalitis predominated with the clinical picture of hepatitis has rarely been recorded in populations other than neonates. Case Presentation: A male 2-year-old, presenting with a fever of 38 to 40 °C with chills and rigors, lethargy and drowsiness for 6 days. Along with the nausea, vomiting and watery diarrhea, he developed mouth ulcers (peri-oral vesicles) during the stay at the hospital. After extensive workup he was later diagnosed with meningoencephalitis and acute hepatitis due to Coxsackie virus A. After a stay of more than a month he was successfully treated and discharge. Conclusion: A more thorough evaluation should be carried out for atypical viral infections presenting with clinical presentation of hepatitis and meningoencephalitis.

scholarly journals Study of haematological, biochemical profile and clinical presentation in dengue positive patients: 82 cases

2018 ◽  
Vol 6 (6) ◽  
pp. 2099
Author(s):  
Mubin I. Patel ◽  
Abhishek Patel ◽  
Avani Patel ◽  
Sharmistha Patel ◽  
Suresh Padsala
Keyword(s):  
Dengue Fever ◽  
Clinical Presentation ◽  
Liver Enzymes ◽  
Neglected Tropical Diseases ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Biochemical Profile ◽  
Igg Antibody ◽  
Aedes Mosquitoes ◽  
Clinical Signs And Symptoms

Background: Dengue Fever (DF) is a self-limiting disease caused by arbovirus and transmitted by Aedes mosquitoes (Aedes aegypti and Aedes albopictus). It is one of the 17 neglected tropical diseases by WHO. Diagnosis of dengue depends mainly on the detection of IgM and IgG antibody, and NS1 antigen.Methods: The study was carried out in Department of Pathology, affiliated with a government hospital. It includes 82 dengue patients, admitted from August 2015 to August 2016. Haematological, biochemical profile, clinical signs and symptoms were recorded. The Tourniquet test was performed in all the patients on admission. Grading of dengue: DF/DHFI/DHFII/DHFIII/DHFIV. Grade III and IV were collectively called as Dengue Shock Syndrome.Results: Total 82 Dengue positive cases were studied, 52 (63%) were males and 30 (37%) were females. 24 (29%) patients were recorded in September 22 (27%) in October 19 (23%) in August. 12 (14.60%) had positive tourniquet test. Thrombocytopenia was present in 86.5 % patients. Majority cases were of classical dengue fever 51 (62.20%), 14 (17.07%) were of DHF I, 12 (14.63%) were of DHF II, 3 (3.66%) were of DHF III and 2 (2.44%) were of DHF IV.Conclusions: It is very important to correlate clinical examination with haematological and biochemical profile in dengue patients. Hematocrit value, leucopenia, thrombocytopenia, raised liver enzymes is very important to monitor dengue cases in their initial stages and thus facilitate early treatment. This would minimize morbidity and mortality arising out of serious complications of dengue fever.

scholarly journals Hepatitis B and C Viral Infection in B-Thalassemic Children

2019 ◽  
Vol 10 (4) ◽  
pp. 3733-3737
Author(s):  
Mokhles Mahdi Abolewaikh Almayyahi ◽  
Flayyih Hassan Shnawa Al-Hameedawi
Keyword(s):  
Hepatitis C ◽  
Liver Injury ◽  
Hepatitis B ◽  
Viral Infection ◽  
Hepatitis A ◽  
Liver Enzymes ◽  
Female Ratio ◽  
Liver Functions

The main objective of this study is to show how both hepatitis B and C Viral Infection in B-Thalassemic patients occurs and a study of their liver functions. To define the occurrence of either hepatitis A or B and C viral infection across the B-Thalassemia key clients/patients in Thalassemia Center of AL-Diwanyia Maternity and Children hospital from 1st. Jan. –  1st.Nov.2017. To carry out the study, it enlisted 54 patients; 31 patients were male (57.4%) in which the male to the female ratio was 01.4:01. Results for this study revealed that 2 patients had Hepatitis B (3.7%), and 6 patients had Hepatitis C (11.1%). The Liver enzymes were significantly more in those patients having either Hepatitis B or C viral infection. According to this study, it was revealed that the occurrence of HBsAg seropositive in B-thalassemic patients was 307%, and Anti-HCV seropositive were 11.1%, and the rate is lower than reported in many countries. The occurrence of Anti-HCV seropositive is higher than that for HBsAg seropositive. Also, the probability of having liver injury was high for thalassemic patients whom were HBsAg positive & Anti-HCV positive than that of seronegative for HBsAg & Anti- HCV.

Hydralazine-induced liver injury: a review and discussion

2021 ◽  
Vol 14 (8) ◽  
pp. e243278 ◽  
Author(s):  
Meeta Bhardwaj ◽  
Nakul Jay Bhardwaj ◽  
Kendra Cueto ◽  
T Colin Killeen
Keyword(s):  
Side Effects ◽  
Liver Injury ◽  
Antihypertensive Agent ◽  
Adverse Reactions ◽  
Liver Enzymes ◽  
Injury Pattern ◽  
Hypertension Management ◽  
Close Monitoring ◽  
Hepatocellular Injury ◽  
Specific Symptoms

Hydralazine is a commonly prescribed antihypertensive agent. Some of its labelled adverse reactions include lupus-like syndrome, tachycardia, headache and fever. Despite its well-known side effects, little is known about hydralazine’s hepatotoxic effects. We report the case of a 54-year-old female patient who was started on hydralazine for hypertension management but later presented with hydralazine-induced liver injury. Her initial presentation consisted of non-specific symptoms and a hepatocellular injury pattern. Liver biopsy revealed hepatic steatosis. Three weeks after discontinuation of hydralazine, the patient’s liver enzymes normalised, and her symptoms resolved. Few studies have examined the incidence and mechanism by which hydralazine induces a liver injury pattern. With this case, we review the literature, the pathogenesis involved and the eventual management of hydralazine-induced liver injury. We propose close monitoring of liver enzymes for patients on hydralazine throughout their treatment course.

scholarly journals Enoxaparin-Induced Liver Injury

2020 ◽  
Vol 14 (2) ◽  
pp. 315-319 ◽  
Author(s):  
Shehriyar Mehershahi ◽  
Nikhitha Mantri ◽  
Aneesh Kumar ◽  
Shaikh Danial ◽  
Patel Harish
Keyword(s):  
Molecular Weight ◽  
Pulmonary Embolism ◽  
Liver Injury ◽  
Low Molecular Weight Heparin ◽  
Liver Enzymes ◽  
Low Molecular Weight ◽  
Dramatic Improvement ◽  
Hepatocellular Injury

Enoxaparin, a form of low-molecular-weight heparin, can cause a rare, underreported, and often reversible form of hepatocellular injury. This report describes a case of enoxaparin-induced hepatotoxicity in a 61-year-old male diagnosed with pulmonary embolism. Elevations of liver enzymes were noted within 1 week of starting the drug, followed by a dramatic improvement upon its discontinuation, with subsequent normalization in the following days.

scholarly journals Disseminated inflammation of the central nervous system associated with acute hepatitis E: a case report

BMC Neurology ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Jan Rahmig ◽  
Arne Grey ◽  
Marco Berning ◽  
Jochen Schaefer ◽  
Martin Lesser ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Central Nervous System ◽  
Nervous System ◽  
Acute Hepatitis ◽  
Liver Enzymes ◽  
Hepatitis E ◽  
Neurological Deficits ◽  
Off Label ◽  
The Central Nervous System ◽  
Acute Hepatitis E

Abstract Background Hepatitis E infection affects over 20 million people worldwide. Reports of neurological manifestations are largely limited to the peripheral nervous system. We report a middle-aged genotype 3c male patient with acute hepatitis E virus (HEV) infection and severe neurological deficits with evidence of multiple disseminated inflammatory lesions of the central nervous system. Case presentation A 42-year-old male patient presented to our emergency department with musculoskeletal weakness, bladder and bowel retention, blurred vision and ascending hypoesthesia up to the level of T8. Serology showed elevated liver enzymes and positive IgM-titers of hepatitis E. Analysis of cerebrospinal fluid (CSF) showed mild pleocytosis and normal levels of glucose, lactate and protein. HEV-RNA-copies were detected in the CSF and stool. Within 3 days after admission the patient became paraplegic, had complete visual loss and absent pupillary reflexes. MRI showed inflammatory demyelination of the optic nerve sheaths, multiple subcortical brain regions and the spinal cord. Electrophysiology revealed axonal damage of the peroneal nerve on both sides with absent F-waves. Treatment was performed with methylprednisolone, two cycles of plasma exchange (PLEX), one cycle of intravenous immunoglobulins (IVIG) and ribavirin which was used off-label. Liver enzymes normalized after 1 week and serology was negative for HEV-RNA after 3 weeks. Follow-up MRI showed progressive demyelination and new leptomeningeal enhancement at the thoracic spine and cauda equina 4 weeks after admission. Four months later, after rehabilitation was completed, repeated MRI showed gliotic transformation of the spinal cord without signs of an active inflammation. Treatment with rituximab was initiated. The patient remained paraplegic and hypoesthesia had ascended up to T5. Nevertheless, he regained full vision. Conclusions Our case indicates a possible association of acute HEV infection with widespread disseminated central nervous system inflammation. Up to now, no specific drugs have been approved for the treatment of acute HEV infection. We treated our patient off-label with ribavirin and escalated immunomodulatory therapy considering clinical progression and the possibility of an autoimmune response targeting nerve cell structures. While response to treatment was rather limited in our case, detection of HEV in patients with acute neurological deficits might help optimize individual treatment strategies.

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