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Cirrhosis II: Pathophysiology

Cirrhosis is a progressive chronic liver injury caused by prolonged inflammation, excessive fibrotic remodeling, and impaired regeneration. Over time, repeated hepatic insults disrupt the liver’s architecture and function, leading to reduced blood flow, impaired bile drainage, and diminished metabolic capacity.Pathophysiology of cirrhosisCirrhosis arises from three main responses to chronic liver damage: inflammation, immune activation, and hepatocyte death. These processes lead to structural...
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Related Experiment Video

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Mapping Hepatic Stellate Cell Morphology in Mouse Models of Liver Fibrosis
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Hepatitis with fibrin-ring granulomas.

B Khanlari1, M Bodmer, L Terracciano

  • 1Dept. Internal Medicine, University Hospital, Basel, Switzerland.

Infection
|October 11, 2007
PubMed
Summary

A 66-year-old woman developed liver issues and fever, initially suspected as allopurinol-induced hepatitis. Further investigation revealed Leishmania infantum infection, leading to a fatal outcome despite treatment.

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Area of Science:

  • Hepatology
  • Infectious Diseases
  • Clinical Medicine

Background:

  • A 66-year-old woman presented with fever, fatigue, and hepatopathy.
  • Medical history included hypertension, type 2 diabetes, and gout treated with allopurinol.

Observation:

  • Initial liver biopsy showed fibrin-ring granulomas, suggesting allopurinol-induced hepatitis.
  • Persistent fever and subsequent pancytopenia after allopurinol withdrawal and steroid initiation prompted further investigation.
  • Bone marrow aspiration identified Leishmania infantum, and a repeat liver biopsy confirmed amastigotes.

Findings:

  • The patient's presentation mimicked drug-induced liver injury but was ultimately caused by visceral leishmaniasis.
  • Despite treatment with liposomal amphotericin B, the patient's condition worsened.
  • The case highlights a rare presentation of leishmaniasis in an immunocompromised patient.

Implications:

  • This case underscores the importance of considering uncommon infections in patients with unexplained hepatopathy and systemic symptoms.
  • Differential diagnosis for drug-induced liver injury should include infectious etiologies, especially in endemic areas.
  • Prompt recognition and appropriate treatment of leishmaniasis are crucial for patient outcomes.