Hepatitis C virus-related fibrosing cholestatic hepatitis after cardiac transplantation: is azathioprine a contributory factor?
We report a patient who acquired hepatitis C virus (HCV) infection at cardiac transplantation, developing fibrosing cholestatic hepatitis (FCH) with early liver failure and a fatal outcome. FCH is a recently described clinicopathological entity characterized by a cholestatic pattern of serum liver enzyme abnormalities, a progressive course leading to liver failure, and a pathological picture defined by periportal fibrosis, neutrophilic infiltrates and signs of histological cholestasis. Although it was initially described secondary to hepatitis B virus infection, it has also been recently related to HCV infection. Some histopathological features consistent with azathioprine hepatotoxicity like cholestasis, perisinusoidal fibrosis, veno-subocclusive lesions and nodular regenerative hyperplasia were also observed in this case. Therefore, a direct cytopathic effect of HCV and the concurrent pathogenic role of azathioprine hepatotoxicity may be involved in the development of this complication of transplantation.
Delgado
J
J
Heart Transplantation Unit, Hospital Doce de Octubre, Madrid, Spain.
Muñoz de Bustillo
E
E
Ibarrola
C
C
Colina
F
F
Morales
J M
JM
Rodriguez
E
E
Aguado
J M
JM
Fuertes
A
A
Gomez
M A
MA
D001379:Azathioprine / Q000008:administration & dosage / Q000009:adverse effects*; D056486:Chemical and Drug Induced Liver Injury / Q000473:pathology*; D002780:Cholestasis, Intrahepatic / Q000139:chemically induced* / Q000473:pathology; D017809:Fatal Outcome; D016027:Heart Transplantation; D006526:Hepatitis C / Q000473:pathology*; D006801:Humans; D006965:Hyperplasia; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D008099:Liver / Q000187:drug effects / Q000473:pathology; D008105:Liver Cirrhosis, Biliary / Q000139:chemically induced* / Q000473:pathology; D008115:Liver Regeneration / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000187:drug effects / Q000473:pathology
D007166:Immunosuppressive Agents; D001379:Azathioprine