title: Hepatitis with fibrin-ring granulomas.
abstract: We describe a 66-year-old woman hospitalized with fever, fatigue and hepatopathy. In her medical history arterial hypertension (treated with propranolol and lisinopril), diabetes mellitus type 2 (no treatment before admission) and a gout arthropathy were noted wherefore a therapy with allopurinol 300 mg per day has been started 4 months before. Liver biopsy revealed fibrin-ring granulomas, compatible with allopurinol-induced hepatitis. Because of persistence of high fever after stopping allopurinol, steroids (1 mg/kg) were started. Under this treatment, she developed pancytopenia and fever. The bone marrow aspiration revealed Leishmania infantum. A second liver biopsy showed amastigotes and a disappearance of the granulomas. The history revealed a travel to Malta 2 years earlier. Despite adequate treatment with liposomal amphotericin B the patient deteriorated and finally died in septic shock.
authors.affiliation: Dept. Internal Medicine, University Hospital, Basel, Switzerland.
authors.forename: B
authors.initials: B
authors.lastname: Khanlari
authors.forename: M
authors.initials: M
authors.lastname: Bodmer
authors.forename: L
authors.initials: L
authors.lastname: Terracciano
authors.forename: M H
authors.initials: MH
authors.lastname: Heim
authors.forename: U
authors.initials: U
authors.lastname: Fluckiger
authors.forename: M
authors.initials: M
authors.lastname: Weisser
mesh_terms: D000368:Aged; D000493:Allopurinol / Q000009:adverse effects; D000818:Animals; D001706:Biopsy; D001853:Bone Marrow / Q000469:parasitology; D056486:Chemical and Drug Induced Liver Injury / Q000150:complications* / Q000473:pathology*; D017809:Fatal Outcome; D005260:Female; D005337:Fibrin / Q000378:metabolism*; D006074:Gout Suppressants / Q000009:adverse effects; D006099:Granuloma / Q000139:chemically induced / Q000150:complications* / Q000473:pathology; D006801:Humans; D018314:Leishmania infantum / Q000302:isolation & purification; D007898:Leishmaniasis, Visceral / Q000150:complications* / Q000175:diagnosis; D008099:Liver / Q000469:parasitology / Q000473:pathology* / Q000601:surgery
chemical_list: D006074:Gout Suppressants; D000493:Allopurinol; D005337:Fibrin