Hepatitis in exanthematous mediterranean fever

Area of Science:

• Infectious Diseases
• Hepatology
• Microbiology

Background:

• Rickettsiosis, specifically Mediterranean Exanthematous Fever caused by Rickettsia conorii, can present with significant systemic manifestations.
• Hepatic involvement is a recognized, though not fully understood, complication of this infectious disease.

Purpose of the Study:

• To investigate the extent and nature of hepatic involvement in patients with Rickettsia conorii infection.
• To correlate laboratory findings and liver biopsy results with the presence of the infectious agent.

Main Methods:

• Laboratory tests including liver function tests (SGOT, SGPT, alkaline phosphatase) were performed on 38 patients.
• Liver biopsies were conducted on 26 patients, with subsequent light and electron microscopy.
• Histopathological examination focused on identifying inclusion bodies and cellular changes within Kupffer's cells and epithelioid cells.

Main Results:

• Elevated SGOT, SGPT, and alkaline phosphatase levels were observed in over half of the patients.
• Liver biopsies revealed inclusion corpuscles in Kupffer's cells in 14 patients.
• Granulomatous hepatitis was frequently observed, but the Rickettsia conorii agent was not definitively identified in the liver tissue.

Conclusions:

• Hepatic involvement is common in Rickettsia conorii infections, characterized by elevated liver enzymes and histopathological changes like granulomatous hepatitis.
• While inclusion bodies are present in Kupffer's cells, direct visualization of the Rickettsia conorii organism within the liver remains challenging.
• Further research is needed to elucidate the precise mechanisms of hepatic injury and confirm the presence of the agent in liver tissue during Mediterranean Exanthematous Fever.