BACKGROUND Autoimmune antibodies are detected in many diseases.Viral infections are accompanied by several immunopathological manifestations.Some autoimmune antibodies have been associated with the immune response ind...BACKGROUND Autoimmune antibodies are detected in many diseases.Viral infections are accompanied by several immunopathological manifestations.Some autoimmune antibodies have been associated with the immune response induced by virus or drugs.Thus,a comprehensive diagnosis of chronic hepatitis B combined with autoimmune hepatitis is required,and immunosuppressant or antiviral therapy should be carefully considered.CASE SUMMARY We present a case of a patient who had negative transformation of autoimmune antibodies during chronic active hepatitis B.A 50-year-old female who had a history of asymptomatic hepatitis B virus carriers for more than 10 years presented to the hospital with the complaint of weakness for 1 wk.Blood tests revealed elevated liver enzymes;the detection of autoantibodies was positive.Hepatitis B viral load was 72100000 IU/mL.The patient started tenofovir alafenamide fumigate 25 mg daily.Liver biopsy was performed,which was consistent with chronic active hepatitis B.The final diagnosis of the case was chronic active hepatitis B.The autoimmune antibodies turned negative after 4 wk of antiviral therapy.The patient recovered and was discharged with normal liver function.There was no appearance of autoantibodies,and liver function was normal at regular follow-ups.CONCLUSION Autoimmune antibodies may appear in patients with chronic active hepatitis.It is necessary to differentiate the diagnosis with autoimmune hepatitis.展开更多
BACKGROUND Twenty percent of patients infected with hepatitis B virus(HBV)develop extrahepatic manifestations with HBV detected in the lymph nodes,spleen,bone marrow,kidneys,and skin.HBV infection has been associated ...BACKGROUND Twenty percent of patients infected with hepatitis B virus(HBV)develop extrahepatic manifestations with HBV detected in the lymph nodes,spleen,bone marrow,kidneys,and skin.HBV infection has been associated with some autoimmune disorders.Dermatomyositis(DM)is an idiopathic inflammatory myopathy,which involves a viral infection,and DM has been identified in patients infected with HBV,but there is no direct histological evidence for an association between HBV and DM.CASE SUMMARY We describe a familial HBV-infected patient admitted with liver function abnormality,rashes,a movement disorder,and an elevated level of creatine kinase(CK).A computed tomography scan of the lung showed pulmonary fibrosis,and a liver biopsy identified nodular cirrhosis.An electromyogram revealed myogenic damage,and a muscle biopsy showed nuclear migration in local sarcolemma and infiltration of chronic inflammatory cells.Immunohistochemical staining showed negative results for HBsAg and HBcAg.Fluorescence in situ hybridization showed a negative result for HBV DNA.The patient was diagnosed with HBV-related liver cirrhosis complicated with DM and was treated with methylprednisolone,mycophenolate mofetil,and lamivudine.Eight months later,the patient was readmitted for anorexia and fatigue.The blood examination showed elevated levels of aminotransferases and HBV DNA,however,the CK level was within the normal range.The patient developed a virological breakthrough and lamivudine was replaced with tenofovir.CONCLUSION DM in chronic HBV-infected patients does not always associate with HBV.Antiviral and immunosuppressive drugs should be taken into consideration.展开更多
BACKGROUND Hepatitis B virus(HBV)is a hepatotropic virus that can cause acute and chronic liver damage.According to the world health organization 257 million people are infected with chronic HBV infection worldwide.Su...BACKGROUND Hepatitis B virus(HBV)is a hepatotropic virus that can cause acute and chronic liver damage.According to the world health organization 257 million people are infected with chronic HBV infection worldwide.Super-infection with other hepadnaviruses,including hepatitis A virus(HAV),hepatitis C virus,hepatitis D virus,and hepatitis E virus is associated with increased risk of acute liver failure in patients with chronic HBV.CASE SUMMARY Here,we report a case of a 47-year old male patient with HBV-related compensated Child A cirrhosis,who presented with general fatigue,malaise and laboratory signs of acute hepatitis.Although the patient was regularly seen at a specialized university liver unit,the HAV vaccination status was unclear.Acute HAV super-infection was diagnosed by positive serological and polymerase chain reaction analysis.Following acute HAV super-infection,spontaneous HBsAg elimination and development of an anti-HBs titer were observed.CONCLUSION This case illustrates the importance of carefully checking the vaccination status.In our patient,unspecific immunological responses to HAV led to functional cure of HBV.展开更多
1病例资料患者男性,51岁,因＂间断乏力8个月余,面黄、目黄、尿黄10 d＂于2015年1月5日入院。既往史：1年前曾有献血史,否认病毒性肝炎病史及家族史,否认吸烟史,偶有少量饮酒,无特殊用药史。查体：血压120/72 mm Hg,一般状态尚可,面色晦...1病例资料患者男性,51岁,因＂间断乏力8个月余,面黄、目黄、尿黄10 d＂于2015年1月5日入院。既往史：1年前曾有献血史,否认病毒性肝炎病史及家族史,否认吸烟史,偶有少量饮酒,无特殊用药史。查体：血压120/72 mm Hg,一般状态尚可,面色晦暗,皮肤、巩膜重度黄染,浅表淋巴结未触及肿大,无肝掌、蜘蛛痣,腹部平坦,未见腹壁静脉曲张,无压痛、反跳痛、肌紧张,肝、展开更多
BACKGROUND Combined tumors comprising large-cell neuroendocrine carcinoma and hepatocellular carcinoma have been rarely reported in the literature.CASE SUMMARY We report a case of a 73-year-old woman with chronic hepa...BACKGROUND Combined tumors comprising large-cell neuroendocrine carcinoma and hepatocellular carcinoma have been rarely reported in the literature.CASE SUMMARY We report a case of a 73-year-old woman with chronic hepatitis B suspected to have a malignant hepatic mass(segment 3;size,4.5 cm)and lymph node metastasis based on computed tomography and magnetic resonance imaging.Despite being Child-Pugh class A,esophageal varices were present.She underwent left lateral sectionectomy and lymph node dissection.Pathological examination revealed a collision tumor consisting of large-cell neuroendocrine(90%)and hepatocellular(10%)carcinomas.The combined carcinoma had metastasized to one of the three lymph nodes excised.The patient recovered without any postoperative complications and was discharged in good condition on postoperative day 13.Adjuvant chemotherapy was not performed.No recurrence occurred during a follow-up period of 24 mo.CONCLUSION To improve the therapeutic management of combined tumors in the liver,it is necessary to discuss each clinical experience and consider an appropriate method for the preoperative diagnosis and treatment.展开更多
文摘BACKGROUND Autoimmune antibodies are detected in many diseases.Viral infections are accompanied by several immunopathological manifestations.Some autoimmune antibodies have been associated with the immune response induced by virus or drugs.Thus,a comprehensive diagnosis of chronic hepatitis B combined with autoimmune hepatitis is required,and immunosuppressant or antiviral therapy should be carefully considered.CASE SUMMARY We present a case of a patient who had negative transformation of autoimmune antibodies during chronic active hepatitis B.A 50-year-old female who had a history of asymptomatic hepatitis B virus carriers for more than 10 years presented to the hospital with the complaint of weakness for 1 wk.Blood tests revealed elevated liver enzymes;the detection of autoantibodies was positive.Hepatitis B viral load was 72100000 IU/mL.The patient started tenofovir alafenamide fumigate 25 mg daily.Liver biopsy was performed,which was consistent with chronic active hepatitis B.The final diagnosis of the case was chronic active hepatitis B.The autoimmune antibodies turned negative after 4 wk of antiviral therapy.The patient recovered and was discharged with normal liver function.There was no appearance of autoantibodies,and liver function was normal at regular follow-ups.CONCLUSION Autoimmune antibodies may appear in patients with chronic active hepatitis.It is necessary to differentiate the diagnosis with autoimmune hepatitis.
基金Supported by Natural Science Foundation of Jilin Science and Technology Department,No.20190201065JC
文摘BACKGROUND Twenty percent of patients infected with hepatitis B virus(HBV)develop extrahepatic manifestations with HBV detected in the lymph nodes,spleen,bone marrow,kidneys,and skin.HBV infection has been associated with some autoimmune disorders.Dermatomyositis(DM)is an idiopathic inflammatory myopathy,which involves a viral infection,and DM has been identified in patients infected with HBV,but there is no direct histological evidence for an association between HBV and DM.CASE SUMMARY We describe a familial HBV-infected patient admitted with liver function abnormality,rashes,a movement disorder,and an elevated level of creatine kinase(CK).A computed tomography scan of the lung showed pulmonary fibrosis,and a liver biopsy identified nodular cirrhosis.An electromyogram revealed myogenic damage,and a muscle biopsy showed nuclear migration in local sarcolemma and infiltration of chronic inflammatory cells.Immunohistochemical staining showed negative results for HBsAg and HBcAg.Fluorescence in situ hybridization showed a negative result for HBV DNA.The patient was diagnosed with HBV-related liver cirrhosis complicated with DM and was treated with methylprednisolone,mycophenolate mofetil,and lamivudine.Eight months later,the patient was readmitted for anorexia and fatigue.The blood examination showed elevated levels of aminotransferases and HBV DNA,however,the CK level was within the normal range.The patient developed a virological breakthrough and lamivudine was replaced with tenofovir.CONCLUSION DM in chronic HBV-infected patients does not always associate with HBV.Antiviral and immunosuppressive drugs should be taken into consideration.
文摘BACKGROUND Hepatitis B virus(HBV)is a hepatotropic virus that can cause acute and chronic liver damage.According to the world health organization 257 million people are infected with chronic HBV infection worldwide.Super-infection with other hepadnaviruses,including hepatitis A virus(HAV),hepatitis C virus,hepatitis D virus,and hepatitis E virus is associated with increased risk of acute liver failure in patients with chronic HBV.CASE SUMMARY Here,we report a case of a 47-year old male patient with HBV-related compensated Child A cirrhosis,who presented with general fatigue,malaise and laboratory signs of acute hepatitis.Although the patient was regularly seen at a specialized university liver unit,the HAV vaccination status was unclear.Acute HAV super-infection was diagnosed by positive serological and polymerase chain reaction analysis.Following acute HAV super-infection,spontaneous HBsAg elimination and development of an anti-HBs titer were observed.CONCLUSION This case illustrates the importance of carefully checking the vaccination status.In our patient,unspecific immunological responses to HAV led to functional cure of HBV.
文摘1病例资料患者男性,51岁,因＂间断乏力8个月余,面黄、目黄、尿黄10 d＂于2015年1月5日入院。既往史：1年前曾有献血史,否认病毒性肝炎病史及家族史,否认吸烟史,偶有少量饮酒,无特殊用药史。查体：血压120/72 mm Hg,一般状态尚可,面色晦暗,皮肤、巩膜重度黄染,浅表淋巴结未触及肿大,无肝掌、蜘蛛痣,腹部平坦,未见腹壁静脉曲张,无压痛、反跳痛、肌紧张,肝、
文摘BACKGROUND Combined tumors comprising large-cell neuroendocrine carcinoma and hepatocellular carcinoma have been rarely reported in the literature.CASE SUMMARY We report a case of a 73-year-old woman with chronic hepatitis B suspected to have a malignant hepatic mass(segment 3;size,4.5 cm)and lymph node metastasis based on computed tomography and magnetic resonance imaging.Despite being Child-Pugh class A,esophageal varices were present.She underwent left lateral sectionectomy and lymph node dissection.Pathological examination revealed a collision tumor consisting of large-cell neuroendocrine(90%)and hepatocellular(10%)carcinomas.The combined carcinoma had metastasized to one of the three lymph nodes excised.The patient recovered without any postoperative complications and was discharged in good condition on postoperative day 13.Adjuvant chemotherapy was not performed.No recurrence occurred during a follow-up period of 24 mo.CONCLUSION To improve the therapeutic management of combined tumors in the liver,it is necessary to discuss each clinical experience and consider an appropriate method for the preoperative diagnosis and treatment.
