Related Experiment Videos
[1 case of chronic active hepatitis]
Insights
A young woman with chronic active hepatitis experienced severe liver, joint, cardiac, pulmonary, and adrenal complications, leading to death within 18 months. Long-term immunosuppressive therapy was implicated in these systemic lesions.
Area of Science:
- Hepatology
- Immunology
- Pathology
Background:
- Chronic active hepatitis following viral hepatitis can present with severe extrahepatic manifestations.
- The case highlights the potential for widespread organ damage in aggressive hepatitis cases.
Observation:
- An 18-year-old female patient with chronic active hepatitis exhibited jaundice, intrahepatic cholestasis, joint pain, and lesions in the heart, lungs, and adrenal glands.
- Electron microscopy revealed hepatitis B surface antigen (HBsAg) in hepatic cell nuclei despite its absence in blood.
- Adrenal glands showed diffuse hemorrhages, cortical thinning, reduced fascicular zone, and decreased cellular lipids.
Findings:
- Hepatitis B surface antigen (HBsAg) presence within hepatocytes, despite seronegativity, suggests persistent viral activity or unique immune response.
- Systemic lesions affecting multiple organs indicate a complex disease process beyond primary liver pathology.
- Adrenal gland pathology points to significant endocrine dysfunction.
Implications:
- This case underscores the critical need for vigilant monitoring of patients with chronic active hepatitis for systemic complications.
- The findings suggest a potential role for immunosuppressive therapy (prednisolone, immuran) in exacerbating or causing multi-organ lesions, possibly through delayed-type hypersensitivity.
- Further research into the mechanisms of HBsAg nuclear localization and drug-induced organ damage in hepatitis is warranted.
Abstract:
A female patient is described, aged 18, with chronic active hepatitis post viral hepatitis, that led to exitus lethalis within one year and a half. Besides the numberous icteric periods and symptoms for intrahepatal cholestasis, the disease advanced with joint complaints, cardiac pulmonary and adrenal lesions. HBsAg is absent from blood but the latter was found in the nuclei of hapatic cells via electron microscopy. Diffusive hemorrhages were found in both adrenals as well as cortex thinness, reduction of fascicular zone and reduced lipids in cells. The role of the long-term immunosuppressive therapy with prednisolon and immuran is discussed in the origination of liver, adrenal, cardiac and pulmonary lesions (delayed type medicamentosus supersensitivity).