title: Fibrosing cholestatic hepatitis-like syndrome in hepatitis B virus-negative and hepatitis C virus-negative renal transplant recipients.
abstract: Cholestatic hepatitis and diffuse liver fibrosis have been described in immunosuppressed patients with hepatitis B virus or hepatitis C virus infection as fibrosing cholestatic hepatitis (FCH). FCH is characterized by cholestasis, with only a modest increase in aminotransferase levels. The pathologic picture typically shows periportal and perisinusoidal fibrosis, scarce mixed infiltrates, hepatocellular ballooning, and histologic cholestasis. We report two patients with diffuse fibrosis and cholestasis quite similar to the histologic picture of FCH, but in whom neither hepatitis B virus nor hepatitis C virus infection could be shown, highlighting the potential contribution of cytomegalovirus infection and azathioprine toxicity in the development of this severe complication of solid-organ transplantation.
authors.affiliation: Department of Nephrology, Renal Transplant Unit, and Department of Pathology, Hospital Universitario Doce de Octubre, Madrid, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Muñoz de Bustillo
authors.forename: A
authors.initials: A
authors.lastname: Benito
authors.forename: F
authors.initials: F
authors.lastname: Colina
authors.forename: A
authors.initials: A
authors.lastname: Andrés
authors.forename: B
authors.initials: B
authors.lastname: Domínguez-Gil
authors.forename: M A
authors.initials: MA
authors.lastname: Muñoz
authors.forename: J L
authors.initials: JL
authors.lastname: Rodicio
authors.forename: J M
authors.initials: JM
authors.lastname: Morales
mesh_terms: D000328:Adult; D001379:Azathioprine / Q000008:administration & dosage; D002779:Cholestasis / Q000150:complications / Q000473:pathology* / Q000821:virology; D017809:Fatal Outcome; D006505:Hepatitis / Q000150:complications / Q000473:pathology* / Q000821:virology; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D016030:Kidney Transplantation / Q000009:adverse effects*; D008103:Liver Cirrhosis / Q000150:complications / Q000473:pathology* / Q000821:virology; D008297:Male; D013577:Syndrome
chemical_list: D007166:Immunosuppressive Agents; D001379:Azathioprine