Steroidal management and serum cytokine profile of a case of alcoholic hepatitis with leukemoid reaction.
Leukemoid reactions (LRs) are rare in alcoholic hepatitis (AH), but they are a sign of poor prognosis. The treatment of AH with corticosteroids is controversial, though several reports suggest that these should be used in severe cases of AH. We report a case of AH-associated LRs that presented with an increase of the serum concentrations of the proinflammatory cytokines interleukin (IL)-18 (an initiator of inflammation) and IL-1beta (likely responsible for the neutrophilia of the LRs). These findings provided a pathogenic indication for the use of corticosteroids (that block the transcription of IL-1beta), and this approach achieved a clinical and analytical recovery in our patient. This pathogenic mechanism might also underlie other cases of LRs and other complications of AH, thus providing a rationale for the benefits of corticotherapy in these rare but severe conditions.
Argüelles-Grande
C
C
Dept of Primary Health Care, Ramón y Cajal Hospital, Madrid, Spain.
Leon
F
F
Matilla
J
J
Domínguez
J
J
Montero
J
J
D000328:Adult; D016207:Cytokines / Q000097:blood*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006519:Hepatitis, Alcoholic / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D007955:Leukemoid Reaction / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D008775:Methylprednisolone / Q000627:therapeutic use*; D016896:Treatment Outcome
D016207:Cytokines; D005938:Glucocorticoids; D008775:Methylprednisolone