BACKGROUND While tuberculosis(TB)itself is a common disease,isolated TB of the liver is a rare entity.Tubercular involvement of the liver is more commonly a part of a disseminated disease of the hepatic parenchyma.In ...BACKGROUND While tuberculosis(TB)itself is a common disease,isolated TB of the liver is a rare entity.Tubercular involvement of the liver is more commonly a part of a disseminated disease of the hepatic parenchyma.In contrast,isolated hepatic TB spread through the portal vein from the gastrointestinal tract is seldom encountered in clinical practice,with only a few sporadic cases and short series available in the current literature.Vascular complications,such as portal vein thrombosis(PVT),have rarely been reported previously.CASE SUMMARY A 22-year-old man was hospitalized with complaints of a 3-mo history of fever and weight loss of approximately 10 kg.He had a 10-year hepatitis B virus(HBV)infection in his medical history.Contrast-enhanced computed tomography(CECT)confirmed hepatosplenomegaly,with hypodensity of the right lobe of the liver and 2.1 cm thrombosis of the right branch of the portal vein.A liver biopsy showed epithelioid granulomas with a background of caseating necrosis.ZiehlNelson staining showed acid-fast bacilli within the granulomas.The patient was diagnosed with isolated hepatic TB with PVT.Anti-TB therapy(ATT),including isoniazid,rifapentine,ethambutol,and pyrazinamide,was administered.Along with ATT,the patient was treated with entecavir as an antiviral medication against HBV and dabigatran as an anticoagulant.He remained asymptomatic,and follow-up sonography of the abdomen at 4 mo showed complete resolution of the PVT.CONCLUSION Upon diagnosis of hepatic TB associated with PVT and HBV coinfection,ATT and anticoagulants should be initiated to prevent subsequent portal hypertension.Antiviral therapy against HBV should also be administered to prevent severe hepatic injury.展开更多
BACKGROUND Hepatic tuberculosis(TB)is uncommon clinically.Because of a lack of specific signs,characteristic symptoms and clinical manifestations and because pathological samples are difficult to obtain,hepatic TB is ...BACKGROUND Hepatic tuberculosis(TB)is uncommon clinically.Because of a lack of specific signs,characteristic symptoms and clinical manifestations and because pathological samples are difficult to obtain,hepatic TB is easily missed or misdiagnosed.CASE SUMMARY A 62-year-old Chinese man presented with jaundice for 1 wk and no abnormal laboratory tests other than elevated bilirubin,aminotransferases and C-reactive protein.Computed tomography(CT)of the abdomen showed a mass in the left lobe of the liver and hepatic hilum with striped calcified foci.Mild enhancement was visible at the edges,along with extensive intrahepatic biliary ductal dilatation in the right lobe of the liver.In the arterial phase of both CT and magnetic resonance imaging,the main trunk and right branch of the portal artery were partially visualized.Magnetic resonance cholangiopancreatography(MRCP)indicated that the left lobe of the liver and most of the bile ducts in the hilum were not visible.Pathological examination revealed coagulative necrosis,and granulomatous nodules were seen around areas of necrosis;therefore,TB was considered.CONCLUSION Hepatic tuberculosis is easily misdiagnosed or missed on imaging.Percutaneous puncture biopsy is the most useful tool for definitive diagnosis.展开更多
Hepatitis associated anti-tuberculous treatment（HATT） has been a main obstacle in managing patients co-infected with Mycobacterium tuberculosis and hepatitis B virus（HBV）. Therefore, we evaluated the factors relat...Hepatitis associated anti-tuberculous treatment（HATT） has been a main obstacle in managing patients co-infected with Mycobacterium tuberculosis and hepatitis B virus（HBV）. Therefore, we evaluated the factors related to the severity of adverse effects during HATT, especially those associated with liver failure. A retrospective study was carried out at Tongji Hospital from 2007 to 2012. Increases in serum transaminase levels of 〉3, 5, and 10 times the upper limit of normal（ULN） were used to define liver damage as mild, moderate, and severe, respectively. Patients with elevated total bilirubin（TBil） levels that were more than 10 times the ULN（〉171 μmol/L） with or without decreased（〈40%） prothrombin activity（PTA） were diagnosed with liver failure. A cohort of 87 patients was analyzed. The incidence of liver damage and liver failure was 59.8%（n=52） and 25.3%（n=22）, respectively. The following variables were correlated with the severity of hepatotoxicity： albumin（ALB） levels, PTA, platelet counts（PLT）, and the use of antiretroviral therapies（P〈0.05）. Hypo-proteinemia and antiretroviral therapy were significantly associated with liver failure, and high viral loads were a significant risk factor with an odds ratio（OR） of 2.066. Judicious follow-up of clinical conditions, liver function tests, and coagulation function, especially in patients with high HBV loads and hypoalbuminemia is recommended. It may be advisable to reconsider the use of antiviral drugs failure during the course of anti-tuberculous treatment of HBV infection patients to avoid the occurrence of furious liver failure.展开更多
Background:Developing a granulomatous liver injury preclinical model may pave the way to understanding hepatic-TB(tuberculosis)and autoimmune granulomatous liver diseases.Antitubercular(ATT)and other drugs'metabol...Background:Developing a granulomatous liver injury preclinical model may pave the way to understanding hepatic-TB(tuberculosis)and autoimmune granulomatous liver diseases.Antitubercular(ATT)and other drugs'metabolism in the presence of a specific type of liver injury is not well understood.The present study aimed to establish a preclinical model of granulomatous hepatitis by using the BCG(Bacillus CalmetteGuérin)vaccine,further studying it in the presence of ATT dosing,and analyze the pharmacokinetics of isoniazid,rifampicin,and their respective primary metabolites.Methods:We used 56 rats in seven equal groups.Group I functioned as a normal control(NC)receiving normal saline only.Groups II-IV received intravenous injections of low-,medium-,and high-dose BCG vaccine daily for 21 days.Groups V,VI,and VII received isoniazid(H)alone,rifampicin(R)alone,and isoniazid+rifampicin(HR)for a subsequent 15 days in addition to high dose BCG for the first 21 days,respectively.Liver function tests(LFT)were monitored on days 0,21,28,and 36.Rats were sacrificed later for oxidative stress and histopathological examination.Results:The study observed BCG dose-specific LFT derangements in groups II-IV compared to group I on day 21(p<0.05).Isoniazid,rifampicin,and combination intervention groups demonstrated normalization of the BCG-led LFT changes.Histology and oxidative stress parameters confirmed model development and biochemical changes.Isoniazid area under the curve(AUC)showed a reduction of 16.9%in BCG+HR group in comparison to the BCG+H group(p=0.01).Des-acetyl-rifampicin AUC and maximum-concentration value demonstrated a significant rise in BCG+HR group in comparison to the BCG+R group(p=0.001).Conclusion:A novel preclinical model of granulomatous liver injury was developed using the BCG vaccine strain and validated with ATT response.展开更多
文摘BACKGROUND While tuberculosis(TB)itself is a common disease,isolated TB of the liver is a rare entity.Tubercular involvement of the liver is more commonly a part of a disseminated disease of the hepatic parenchyma.In contrast,isolated hepatic TB spread through the portal vein from the gastrointestinal tract is seldom encountered in clinical practice,with only a few sporadic cases and short series available in the current literature.Vascular complications,such as portal vein thrombosis(PVT),have rarely been reported previously.CASE SUMMARY A 22-year-old man was hospitalized with complaints of a 3-mo history of fever and weight loss of approximately 10 kg.He had a 10-year hepatitis B virus(HBV)infection in his medical history.Contrast-enhanced computed tomography(CECT)confirmed hepatosplenomegaly,with hypodensity of the right lobe of the liver and 2.1 cm thrombosis of the right branch of the portal vein.A liver biopsy showed epithelioid granulomas with a background of caseating necrosis.ZiehlNelson staining showed acid-fast bacilli within the granulomas.The patient was diagnosed with isolated hepatic TB with PVT.Anti-TB therapy(ATT),including isoniazid,rifapentine,ethambutol,and pyrazinamide,was administered.Along with ATT,the patient was treated with entecavir as an antiviral medication against HBV and dabigatran as an anticoagulant.He remained asymptomatic,and follow-up sonography of the abdomen at 4 mo showed complete resolution of the PVT.CONCLUSION Upon diagnosis of hepatic TB associated with PVT and HBV coinfection,ATT and anticoagulants should be initiated to prevent subsequent portal hypertension.Antiviral therapy against HBV should also be administered to prevent severe hepatic injury.
文摘BACKGROUND Hepatic tuberculosis(TB)is uncommon clinically.Because of a lack of specific signs,characteristic symptoms and clinical manifestations and because pathological samples are difficult to obtain,hepatic TB is easily missed or misdiagnosed.CASE SUMMARY A 62-year-old Chinese man presented with jaundice for 1 wk and no abnormal laboratory tests other than elevated bilirubin,aminotransferases and C-reactive protein.Computed tomography(CT)of the abdomen showed a mass in the left lobe of the liver and hepatic hilum with striped calcified foci.Mild enhancement was visible at the edges,along with extensive intrahepatic biliary ductal dilatation in the right lobe of the liver.In the arterial phase of both CT and magnetic resonance imaging,the main trunk and right branch of the portal artery were partially visualized.Magnetic resonance cholangiopancreatography(MRCP)indicated that the left lobe of the liver and most of the bile ducts in the hilum were not visible.Pathological examination revealed coagulative necrosis,and granulomatous nodules were seen around areas of necrosis;therefore,TB was considered.CONCLUSION Hepatic tuberculosis is easily misdiagnosed or missed on imaging.Percutaneous puncture biopsy is the most useful tool for definitive diagnosis.
基金supported in part by the Organization Department of the Central Committee of the Communist Party of China 2015“sunshine of the west”visiting scholar program(No.2903)
文摘Hepatitis associated anti-tuberculous treatment（HATT） has been a main obstacle in managing patients co-infected with Mycobacterium tuberculosis and hepatitis B virus（HBV）. Therefore, we evaluated the factors related to the severity of adverse effects during HATT, especially those associated with liver failure. A retrospective study was carried out at Tongji Hospital from 2007 to 2012. Increases in serum transaminase levels of 〉3, 5, and 10 times the upper limit of normal（ULN） were used to define liver damage as mild, moderate, and severe, respectively. Patients with elevated total bilirubin（TBil） levels that were more than 10 times the ULN（〉171 μmol/L） with or without decreased（〈40%） prothrombin activity（PTA） were diagnosed with liver failure. A cohort of 87 patients was analyzed. The incidence of liver damage and liver failure was 59.8%（n=52） and 25.3%（n=22）, respectively. The following variables were correlated with the severity of hepatotoxicity： albumin（ALB） levels, PTA, platelet counts（PLT）, and the use of antiretroviral therapies（P〈0.05）. Hypo-proteinemia and antiretroviral therapy were significantly associated with liver failure, and high viral loads were a significant risk factor with an odds ratio（OR） of 2.066. Judicious follow-up of clinical conditions, liver function tests, and coagulation function, especially in patients with high HBV loads and hypoalbuminemia is recommended. It may be advisable to reconsider the use of antiviral drugs failure during the course of anti-tuberculous treatment of HBV infection patients to avoid the occurrence of furious liver failure.
文摘Background:Developing a granulomatous liver injury preclinical model may pave the way to understanding hepatic-TB(tuberculosis)and autoimmune granulomatous liver diseases.Antitubercular(ATT)and other drugs'metabolism in the presence of a specific type of liver injury is not well understood.The present study aimed to establish a preclinical model of granulomatous hepatitis by using the BCG(Bacillus CalmetteGuérin)vaccine,further studying it in the presence of ATT dosing,and analyze the pharmacokinetics of isoniazid,rifampicin,and their respective primary metabolites.Methods:We used 56 rats in seven equal groups.Group I functioned as a normal control(NC)receiving normal saline only.Groups II-IV received intravenous injections of low-,medium-,and high-dose BCG vaccine daily for 21 days.Groups V,VI,and VII received isoniazid(H)alone,rifampicin(R)alone,and isoniazid+rifampicin(HR)for a subsequent 15 days in addition to high dose BCG for the first 21 days,respectively.Liver function tests(LFT)were monitored on days 0,21,28,and 36.Rats were sacrificed later for oxidative stress and histopathological examination.Results:The study observed BCG dose-specific LFT derangements in groups II-IV compared to group I on day 21(p<0.05).Isoniazid,rifampicin,and combination intervention groups demonstrated normalization of the BCG-led LFT changes.Histology and oxidative stress parameters confirmed model development and biochemical changes.Isoniazid area under the curve(AUC)showed a reduction of 16.9%in BCG+HR group in comparison to the BCG+H group(p=0.01).Des-acetyl-rifampicin AUC and maximum-concentration value demonstrated a significant rise in BCG+HR group in comparison to the BCG+R group(p=0.001).Conclusion:A novel preclinical model of granulomatous liver injury was developed using the BCG vaccine strain and validated with ATT response.
