Hepatitis B virus infection of transplanted human hepatocytes causes a biochemical and histological hepatitis in immunocompetent rats

AIM: To characterize the host response to hepatitis B virus (HBV) infection in human hepatocytes transplanted into immunocompetent rodent rats tolerized by, and transplanted with primary human hepatocytes.METHODS: One week after the transplantation, rats were inoculated with HBV, and viral gene expression, replication,and host response was monitored.RESULTS: HBV DNA was detectable in serum for at least 60 days. HBsAg levels rose steadily for 3 weeks postinoculation and then plateaued at a level of about 0.6 pg/mi. HBV RNA was also found in liver at levels that remained constant through the time course. Immunofluorescence revealed clusters of hepatocytes that stained positive for HBcAg. The presence of HBV covalently closed circular DNA (cccDNA) in liver was demonstrated using nuclease digestion of single-stranded DNA followed by PCR. Serum ALT levels rose and reached a peak level of 180 IU/L on day 18, but remained elevated for 60 days. Histology revealed a progressive predominantly mononuclear lobular hepatitis.CONCLUSION: These data indicate that human hepatocytestransplanted into rats rendered tolerant to these cells, when infected by HBV, results in biochemical as well as histological evidence of hepatitis that accompanies viral gene expression,and DNA replication.

Case report and review of esophageal lichen planus treated with fluticasone

Lichen planus is a fairly common chronic idiopathic disorder of the skin,nails and mucosal surfaces.Esophageal involvement of this disease on the other hand is rare and only about 50 cases have been reported in literature.Given its rarity,it can be difficult to diagnose and may be easily misdiagnosed as reflux esophagitis.Currently,there are no clear recommendations on the optimal management of this disease and little is known about the best treatment approach.Systemic steroids are usually the first line treatment and offer a favorable response.In this report,we would like to present a novel approach in the management of esophageal lichen planus in a middle-aged woman treated successfully with swallowed fluticasone propionate 220 mcg twice a day for 6 wk,as evidenced by objective clinical findings.Based on our review of related literature and experience in this patient,we feel that a trial of swallowed fluticasone may be a prudent approach in the management of these patients since it has a more favorable side effect profile than systemic treatment.

An ironic case of liver infections:Yersinia enterocolitis in the setting of thalassemia

A 49 years old Vietnamese male with a history of thalassemia,presented with gastrointestinal symptoms and signs of hemolysis.He was diagnosed with yersinia enterocolitis.Yersinia is a gram-negative rod that most frequently occurs in children especially during the winter months.In the current case,the bone marrow biopsy showed hemophagocytosis along with positive cultures for Yersinia.The microorganism likely triggered hemophagocytosis.This syndrome,also known as,hemophagocytic lymphohistiocytosis,is defined by fever for more than 7 d,cytopenia of two or more cell lines,hemophagocytosis,hepatitis,serum ferritin greater than500,jaundice,lymphadenopathy,and hepatosplenomegaly.This disorder can be either familial or secondary to a strong immunologic activation.Both have an overwhelming activation of T-cells and macrophages.

Primary Biliary Cirrhosis and Primary Sclerosing Cholangitis:a Review Featuring a Women's Health Perspective

Primary biliary cirrhosis (PBC) and primary sclerosing cho-langitis (PSC) are two major types of chronic cholestatic liver disease. Each disorder has distinguishing features and variable progression, but both may ultimately result in cirrhosis and hepatic failure. The following offers a review of PBC and PSC, beginning with a general overview of disease etiology, pathogenesis, diagnosis, clinical features, natural course, and treatment. In addition to commonly associated manifestations of fatigue, pruritus, and fat-soluble vitamin deficiency, select disease-related topics pertaining to women's health are discussed including metabolic bone disease, hyperlipidemia and cardiovascular risk, and preg-nancy-related issues influencing maternal disease course and birth outcomes. This comprehensive review of PBC and PSC highlights some unique clinical considerations in the care of female patients with cholestatic liver disease.

Hepatic Sarcoidosis

Sarcoidosis is a multisystem disease characterized by the presence of non-caseating granulomas in affected organs.Pulmonary involvement is the most common site of disease activity.However,hepatic involvement is also common in sarcoidosis,occurring in up to 70% of patients.Most patients with liver involvement are asymptomatic.Therefore,the majority of cases are discovered incidentally,frequently by the finding of elevated liver enzymes.Pain in the right upper quadrant of the abdomen,fatigue,pruritus,and jaundice may be associated with liver involvement.Portal hypertension and cirrhosis are complications linked to long-standing hepatic sarcoidosis.Liver biopsy is usually required to confirm the diagnosis.It is important to differentiate hepatic sarcoidosis from other autoimmune and granulomatous liver diseases.Not all cases of hepatic sarcoidosis require treatment.For symptomatic patients,the first line treatment includes corticosteroids or ursodeoxycholic acid.Various immunosuppressant agents can be used as second line agents.Rarely,severe cases require liver transplantation.