title: Acute intrahepatic cholestasis accompanied with Chlamydophila pneumoniae infection.
abstract: We report a case of Chlamydophila (C.) pneumoniae infection presenting with fever and rapid intrahepatic cholestasis. A 63-year-old man had a week-long history of intermittent high fever and rapidly progressive jaundice with atypical erythema. The results of liver function tests were recorded. The results of all serological tests were negative; the IgM, IgG, and IgA titers for C. pneumoniae had increased, which indicates a C. pneumoniae infection. The patient's fever and liver dysfunction improved upon administration of minocycline. Light microscopic findings showed the presence of enlarged liver cells with clear cytoplasm, a few mitotic figures, multinucleated cells, and bile cholestasis. The electron microscopic appearance of liver biopsy showed that bile canaliculi exhibited intrahepatic forms of cholestasis. From the results of light and electron microscopy, we inferred atypical intrahepatic cholestasis, probably resulting from the C. pneumoniae infection.
authors.affiliation: Department of Internal Medicine, Kitasato University, Kitasato Institute Medical Center Hospital, 6-100 Arai, Kitamoto-shi, Saitama, 364-8501, Japan. m.toyoda@insti.kitasato-u.ac.jp
authors.forename: Megumi
authors.initials: M
authors.lastname: Toyoda-Akui
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Yokomori
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Kaneko
authors.forename: Yuki
authors.initials: Y
authors.lastname: Shimizu
authors.forename: Hajime
authors.initials: H
authors.lastname: Takeuchi
authors.forename: Kumiko
authors.initials: K
authors.lastname: Tahara
authors.forename: Hide
authors.initials: H
authors.lastname: Yoshida
authors.forename: Hirobumi
authors.initials: H
authors.lastname: Kondo
authors.forename: Tadashi
authors.initials: T
authors.lastname: Motoori
authors.forename: Makoto
authors.initials: M
authors.lastname: Ohbu
authors.forename: Masaya
authors.initials: M
authors.lastname: Oda
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Hibi
mesh_terms: D000410:Alanine Transaminase / Q000097:blood; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000907:Antibodies, Bacterial / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D023521:Chlamydophila Infections / Q000150:complications / Q000188:drug therapy / Q000473:pathology*; D016993:Chlamydophila pneumoniae / Q000276:immunology; D002780:Cholestasis, Intrahepatic / Q000150:complications / Q000188:drug therapy / Q000382:microbiology*; D004893:Erythema Nodosum / Q000209:etiology; D005334:Fever / Q000188:drug therapy / Q000382:microbiology; D006801:Humans; D041781:Jaundice, Obstructive / Q000188:drug therapy / Q000382:microbiology; D008099:Liver / Q000473:pathology; D008168:Lung / Q000473:pathology; D008297:Male; D008875:Middle Aged; D008911:Minocycline / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D000907:Antibodies, Bacterial; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D008911:Minocycline