Fibrosing cholestatic hepatitis in a hepatitis B surface antigen carrier after renal transplantation.
A 45-year-old hepatitis B surface antigen carrier had an allograft kidney transplantation and maintenance immunosuppression with cyclosporin A and prednisolone. Six months later, she experienced a rapidly progressive hepatic failure manifested by elevation of serum bilirubin level, prolongation of prothrombin time, and mild to modest increase of serum aminotransferase levels. She died in 6 weeks. Postmortem liver histology showed canalicular and cellular cholestasis and ground-glass appearance and ballooning of most hepatocytes, but only mild inflammatory cell infiltration. Immunohistochemical staining showed massive loads of hepatitis B surface and core antigens in the hepatocytes and extensive periportal fibrosis. The whole picture was compatible with fibrosing cholestatic hepatitis described in hepatitis B virus-infected liver transplant. Sequencing of the hepatitis B virus genome amplified from the patient's serum indicated a precore mutant but few mutations in the core, pre-S, and S genes. Little inflammatory reaction was observed histologically despite HLA compatibility, a situation differing from that in liver transplant. This observation indicates that fibrosing cholestatic hepatitis may also occur in non-liver transplant setting.
Chen
C H
CH
Department of Internal Medicine, College of Medicine, National Taiwan University Hospital, Taipei.
Chen
P J
PJ
Chu
J S
JS
Yeh
K H
KH
Lai
M Y
MY
Chen
D S
DS
D001483:Base Sequence; D002353:Carrier State / Q000276:immunology / Q000473:pathology / Q000821:virology*; D002779:Cholestasis / Q000276:immunology / Q000473:pathology / Q000821:virology*; D005260:Female; D005814:Genes, Viral; D006505:Hepatitis / Q000276:immunology / Q000473:pathology / Q000821:virology*; D006509:Hepatitis B / Q000276:immunology / Q000473:pathology / Q000821:virology*; D006514:Hepatitis B Surface Antigens / Q000097:blood*; D006515:Hepatitis B virus / Q000235:genetics / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D016030:Kidney Transplantation; D008099:Liver / Q000276:immunology / Q000473:pathology / Q000821:virology; D008103:Liver Cirrhosis / Q000276:immunology / Q000473:pathology / Q000821:virology*; D008875:Middle Aged; D008969:Molecular Sequence Data; D009154:Mutation
D006514:Hepatitis B Surface Antigens; D007166:Immunosuppressive Agents