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.
Heart Transplantation Unit, Hospital Doce de Octubre, Madrid, Spain.
J
J
Delgado
E
E
Muñoz de Bustillo
C
C
Ibarrola
F
F
Colina
J M
JM
Morales
E
E
Rodriguez
J M
JM
Aguado
A
A
Fuertes
M A
MA
Gomez
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