http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2013 , Hindawi Publishing Corporation . All rights reserved. Tue, 14 May 2013 16:24:04 +0000 http://www.hindawi.com/crim/hepatology/2013/406901/ The most serious adverse drug reaction of adalimumab (ADR) is tuberculosis reactivation. We describe a case of a 35-year-old man, with rheumatoid arthritis (RA) and hepatitis C virus genotype 1a with a liver biopsy in 2001 with a METAVIR score pattern A1 F0; he received interferon alpha 2b for six months, but treatment was suspended because of reactivation of RA. Liver function tests after treatment were similar to previous ones showing a minimal cholestatic pattern. In 2008, methotrexate was prescribed, but the drug was withdrawn at the third month because of the appearance of pruritus and Ggt rise. Viral load at that moment was 9300000 UI/mL, log 6,9. The liver biopsy showed a Metavir Score A2 F1. Adalimumab was started in 2010, and at the third month of treatment, Ggt showed a rise of 23 times normal value (NV), alkaline phosphatase 2,5 times NV with AST and ALT with no change. A new liver biopsy showed portal inflammation with eosinophils and a METAVIR A1 F2. We think that adalimumab appears to be responsible for the liver injury, because of temporal relationship, liver biopsy findings, other clinical conditions being discarded, and the improvement of clinical symptoms and biochemical abnormalities when adalimumab was suspended. Bernardo Frider, Andres Bruno, Marcelo Ponte, and Marcelo Amante Copyright © 2013 Bernardo Frider et al. All rights reserved. Sun, 12 May 2013 07:58:33 +0000 http://www.hindawi.com/crim/hepatology/2013/610818/ Mycotic hepatic artery aneurysm is a vascular pathology associated with bacterial endocarditis. It is rare in occurrence after the introduction of effective antibiotics. We present a young patient with injection drug abuse associated staphylococcal endocarditis which was successfully treated with antibiotics and valve replacement who presented with abdominal pain. He was found to have mycotic aneurysm of hepatic artery which was successfully treated with coil embolization. Dhara Chaudhari, Atif Saleem, Pranav Patel, Sara Khan, Mark Young, and Gene LeSage Copyright © 2013 Dhara Chaudhari et al. All rights reserved. Wed, 08 May 2013 14:04:07 +0000 http://www.hindawi.com/crim/hepatology/2013/438375/ Hepatitis A virus is the most common acute viral hepatitis worldwide with approximately 1.5 million cases annually. Hepatitis A virus infection in general is self-limited. In rare cases, hepatitis A virus infection may cause renal failure, hemolytic anemia, and/or cholestasis. We report the first case of acute cholestatic hepatitis A virus infection complicated by hemolytic anemia, and renal failure in one patient. A 42-year-old Caucasian male presented with cholestasis, hemolytic anemia and renal failure after consuming street tacos in Central and South America while on a business trip. His protracted course required corticosteroid therapy, multiple sessions of plasma exchange, and numerous units of packed red blood cells. This case demonstrates the importance of vaccination in high-risk adults. A prompt diagnosis of acute hepatitis A virus infection is essential, as uncommon presentations may delay diagnosis leading to permanent morbidity and potentially death in fulminant cases. We also demonstrate the efficacy of treatment of cholestatic hepatitis A virus infection, hemolytic anemia, and renal failure with corticosteroids and plasma exchange. Robert T. Lapp and Fedja Rochling Copyright © 2013 Robert T. Lapp and Fedja Rochling. All rights reserved. Sun, 14 Apr 2013 18:56:47 +0000 http://www.hindawi.com/crim/hepatology/2013/965092/ Herbal medications are being increasingly used by the American population especially for common conditions like arthritis. They have been reported to cause adverse effects, including significant hepatotoxicity, but reporting remains sporadic. We report here a patient who developed drug induced liver injury following the intake of Move Free, which is an over-the-counter arthritis supplement. We propose that Chinese skullcap, which is one of the herbal ingredients of the medication, is responsible for the adverse event. There was a strong temporal association between the intake of supplement and onset of symptoms, and also there have been a few recent case reports implicating the same component. A unique observation in our case is the occurrence of pulmonary infiltrates simultaneously with the hepatotoxicity, and this side effect has not been well documented before. Both the hepatic and pulmonary complications completely resolved over few weeks after the patient stopped taking the medication. Since these supplements are readily available over the counter, we feel that it is important to document possible adverse outcomes to raise awareness in the medical community and also among patients. Renumathy Dhanasekaran, Victoria Owens, and William Sanchez Copyright © 2013 Renumathy Dhanasekaran et al. All rights reserved. Tue, 19 Mar 2013 15:30:15 +0000 http://www.hindawi.com/crim/hepatology/2013/723781/ Solitary necrotic nodule of the liver is a rare benign lesion with a completely necrotic core and a hyalinized fibrotic capsule containing elastic fibers. The pathogenetic mechanism is still unclear. We here describe a case of SNN, whose central reticulin fibers within the nodule suggest the origin as hepatocellular carcinoma or other hepatocyte-origin tumors, treated with laparoscopic anatomical segmentectomy of the liver. A 76-year-old Japanese female, with no prior medical history and no symptom, visited our hospital with the heterogeneous hypoechoic lesion in the liver segment VI incidentally pointed out in abdominal ultrasonography. Computed tomography with contrast demonstrated a 1.1 cm sized low-density lesion with mild ring enhancement on the rim in the arterial phase. Since the possibility of malignant tumor with necrotic change could not be ruled out, she underwent laparoscopic anatomical segmentectomy of the liver. In the histological examination of the surgical specimen, the liver nodule was necrotic tissue without viable cells and signs of inflammation, which had fibrous capsule and central cystic change and showed trabecular pattern alignment of ghost cells and reticulin fibers orthogonal to the capsule. Also, the findings of chronic hepatitis were observed in the background liver. Hirokazu Tomishige, Zenichi Morise, Yoshikazu Mizoguchi, Norihiko Kawabe, Hidetoshi Nagata, Hisanori Ohshima, Jin Kawase, Satoshi Arakawa, Rie Yoshida, and Masashi Isetani Copyright © 2013 Hirokazu Tomishige et al. All rights reserved. Thu, 14 Mar 2013 14:35:19 +0000 http://www.hindawi.com/crim/hepatology/2013/106383/ Emphysematous gastritis is a rare variant of phlegmonous gastritis due to invasion of stomach wall by gas-forming bacteria. It is characterised by abnormal presence of gas in the stomach by imaging, in association with clinical sepsis. Patients suffering from this condition usually present with an underlying pathology. We are reporting a middle-aged Chinese male with hepatitis B virus related hepatocellular carcinoma. He underwent partial hepatectomy and was diagnosed with emphysematous gastritis 4 days after index operation. Emergency laparotomy, including upper endoscopy, was performed. He was managed with antibiotics and discharged 18 days after second operation. This paper shows a review of the literature about the disease, with particular attention to pathology, clinical features, and management. Harry Hok Yee Yu, Simon Tsang, Tan To Cheung, and Chung Mau Lo Copyright © 2013 Harry Hok Yee Yu et al. All rights reserved. Sun, 10 Mar 2013 13:54:10 +0000 http://www.hindawi.com/crim/hepatology/2013/738708/ Angiomyolipomas (AMLs) are benign mesenchymal tumors seen in kidneys in association with tuberous sclerosis. They are uncommon in liver. Angiomyolipomas of liver show great histological diversity and various types and patterns are described. Among them, epithelioid and inflammatory angiomyolipomas are rare. We report a case of epithelioid angiomyolipoma of Liver with an inflammatory component. Jyothi C. R., Dhanya P. Menon, Joy Augustine, and A. K. Abdul Siyad Copyright © 2013 Jyothi C. R. et al. All rights reserved. Sun, 10 Mar 2013 10:23:51 +0000 http://www.hindawi.com/crim/hepatology/2013/146215/ Introduction. Transarterial chemoembolization is the first-line treatment in unresectable hepatocellular carcinoma. There is no standard treatment after transarterial chemoembolization failure. We report the case of a patient with advanced hepatocellular carcinoma who showed a complete response and a long cancer control with hypofractionated stereotactic radiotherapy after transarterial chemoembolization failure. Case Presentation. A 70-year-old Caucasian woman was treated with transarterial chemoembolization for advanced hepatocellular, but no cancer control was obtained. A hypofractionated stereotactic radiotherapy was planned delivering 40 Gy in 5 fractions. A dramatic reduction in alpha-fetoprotein was observed. Contrast-enhanced ultrasonography at 1 and 2 months showed large necrotic areas. Computerised tomography scan showed a 90% objective tumour response, then a complete remission at 3 and 6 months after treatment, respectively. Status of patient remained unchanged for 2 years. Conclusions. Hypofractionated stereotactic radiotherapy can improve survival and prognosis of unresectable hepatocellular carcinoma patient. Francesco Fiorica, Carlo Greco, Sergio Boccia, Sergio Sartori, Antonio Stefanelli, Francesco Cartei, and Stefano Ursino Copyright © 2013 Francesco Fiorica et al. All rights reserved. Sun, 10 Mar 2013 10:21:57 +0000 http://www.hindawi.com/crim/hepatology/2013/948172/ Umbilical herniation is common in patients with liver cirrhosis and ascites. Rarely, they suffer from incarceration and strangulation of the umbilical hernia after treatment of ascites. We report 3 cases of umbilical hernia incarceration following removal of massive ascites with different treatment modalities. Physicians managing this group of patients should be aware of this rare and potentially fatal complication. Hiang Keat Tan and Pik Eu Chang Copyright © 2013 Hiang Keat Tan and Pik Eu Chang. All rights reserved. Wed, 06 Mar 2013 17:40:09 +0000 http://www.hindawi.com/crim/hepatology/2013/320418/ Hydatid cyst rupture into the abdomen is a serious complication of cystic hydatid disease of the liver (Cystic Echinococcosis) with an incidence of up to 16% in some series and can result in anaphylaxis or anaphylactoid reactions in up to 12.5% of cases. At presentation, 36–40% of hydatid cysts have ruptured or become secondarily infected. Rupture can be microscopic or macroscopic and can be fatal without surgery. Hydatid disease of the liver is primarily caused by the tapeworm Echinococcus granulosus and occurs worldwide, with incidence of up to 200 per 100,000 in endemic areas. Our case describes a 24-year-old Bulgarian woman presenting with epigastric pain and evidence of anaphylaxis. Abdominal CT demonstrated a ruptured hydatid cyst in the left lobe of the liver. A partial left lobe hepatectomy, cholecystectomy, and peritoneal washout was performed with good effect. She was treated for anaphylaxis and received antihelminthic treatment with Albendazole and Praziquantel. She made a good recovery following surgery and medical treatment and was well on follow-up. Intraperitoneal rupture with anaphylaxis is a rare occurrence, and there do not seem to be any reported cases from UK centres prior to this. Benjamin Tinsley, Aula Abbara, Raghunandan Kadaba, Hemant Sheth, and Gurjinder Sandhu Copyright © 2013 Benjamin Tinsley et al. All rights reserved. Sun, 03 Mar 2013 15:50:31 +0000 http://www.hindawi.com/crim/hepatology/2013/101862/ We report a rare case of combined hepatocellular carcinoma and fibrolamellar carcinoma arising in a noncirrhotic liver, in a 14-year-old boy who underwent right hepatectomy. We discuss the clinicopathological and immunohistochemical features and the clinical outcome in this unusual tumor. Pradyumn Singh and Banumathi Ramakrishna Copyright © 2013 Pradyumn Singh and Banumathi Ramakrishna. All rights reserved. Thu, 31 Jan 2013 19:11:38 +0000 http://www.hindawi.com/crim/hepatology/2013/531235/ Acute pancreatitis complicating fulminant viral hepatitis has been well recognized; however, acute pancreatitis occurring in nonfulminant hepatitis is very rare. The case presented describes moderate pancreatitis in a young male, manifesting during the course of nonfulminant acute hepatitis E infection. The diagnosis of acute viral hepatitis E was confirmed by serology and reverse transcriptase polymerase chain reaction (RT-PCR) to demonstrate Hepatitis E virus (HEV) RNA in both stool and serum. Patients with acute viral hepatitis presenting with severe abdominal pain should have a diagnosis of acute pancreatitis suspected and appropriate investigations including serum amylase, lipase, biliary ultrasonography and/or contrast-enhanced computed tomography of the abdomen should be undertaken. The identification of this unusual complication of Hepatitis E is important; however, the prognosis for patients with Acute Pancreatitis Complicating Acute Hepatitis E Virus Infection is good, and uncomplicated recovery with conservative treatment is expected. Hemanta Kumar Nayak, Nitish L. Kamble, Nishant Raizada, Sandeep Garg, and Mradul Kumar Daga Copyright © 2013 Hemanta Kumar Nayak et al. All rights reserved. Sun, 20 Jan 2013 14:28:36 +0000 http://www.hindawi.com/crim/hepatology/2013/146261/ Introduction. Few cases of common bile duct stenosis have been reported in the literature, and observations of strictures in the cystic duct are even more rare. Surgical cholecystectomy is the treatment needed in most cases of gallbladder hydrops. This paper describes the diagnosis and successful medical treatment of a rare pediatric case of cystic duct stenosis and gallbladder hydrops. Case Report. A formerly healthy one-year-old girl was admitted with colicky abdominal pain. Blood tests were normal, except for an increase in transaminases. Abdominal ultrasound excluded intestinal intussusception and identified a distended gallbladder with biliary sludge. MR cholangiography revealed a dilated gallbladder containing bile sediment and no detectable cystic duct, while the rest of the intra- and extrahepatic biliary tree and hepatic parenchyma were normal. This evidence was consistent with gallbladder hydrops associated with cystic duct stenosis. The baby was treated with i.v. hydration, corticosteroids, antibiotics, and ursodeoxycholic acid. Her general condition rapidly improved, with no further episodes of abdominal pain and normalization of liver enzymes. This allowed to avoid cholecystectomy, and the child is well 1.5 years after diagnosis. Conclusions. Although cholecystectomy is usually necessary in case of gallbladder hydrops, our experience suggests that surgical procedures can be avoided when the distension is caused by a cystic duct stenosis. Marco Gasparetto, Laura Giordano, Mara Cananzi, Valeria Beltrame, Gianni Bisogno, and Graziella Guariso Copyright © 2013 Marco Gasparetto et al. All rights reserved. Thu, 10 Jan 2013 11:11:01 +0000 http://www.hindawi.com/crim/hepatology/2013/398910/ Primary liver liposarcoma is a rare disease. The knowledge of the clinical course, management, and prognosis of primary liver liposarcoma are all limited because of its rarity. Twelve cases of primary liposarcoma of the liver have been previously reported. We present the thirteenth case, which occurred in an adult male patient. A 42-year-old male patient came to our outpatient department with complaints of pain abdomen, mass per abdomen, and weight loss. Ultrasonography showed a mass arising from the the left lobe of liver. CT abdomen showed a heterogenous enhancing mass from left lobe of liver with multiple cystic and necrotic areas compressing the stomach and spleen with no evidence of metastasis. Differential diagnosis included adenoma and primary malignancy. Exploratory laparotomy and resection were done. HPE was found to be pleomorphic liposarcoma of liver. P. R. Thippeswamy Naik, Prem Kumar, and P. Vinod Kumar Copyright © 2013 P. R. Thippeswamy Naik et al. All rights reserved. Tue, 18 Dec 2012 14:17:49 +0000 http://www.hindawi.com/crim/hepatology/2012/735906/ Cirrhotic or hepatic myelopathy is a rare neurological complication of chronic liver disease usually seen in adults and presents as a progressive pure motor spastic paraparesis which is usually associated with overt liver failure and a surgical or spontaneous systemic portocaval shunt. We describe the development of progressive spastic paraparesis, in a patient with alcoholic cirrhosis with portal hypertension and portal colopathy who presented with the first episode of hepatic encephalopathy. The patient had not undergone any shunt procedure. Madhumita Premkumar, Avishek Bagchi, Neha Kapoor, Ankit Gupta, Gaurav Maurya, Shubham Vatsya, Siddharth Kapahtia, and Premashish Kar Copyright © 2012 Madhumita Premkumar et al. All rights reserved. Mon, 17 Dec 2012 17:07:03 +0000 http://www.hindawi.com/crim/hepatology/2012/209258/ Purpose. Metronidazole-induced encephalopathy (MIE) has been rarely reported. We report a case in a patient with end-stage liver disease (ESLD). Summary. A 63-year-old male with ESLD secondary to hepatitis C virus presented with progressively worsening fatigue, slurred speech, aphasia, vomiting, and left-sided facial droop after completing a 2-week course of metronidazole for recurrent Clostridium difficile-associated diarrhea. He completed a previous course of metronidazole 3 weeks prior to presentation. He is on the liver transplant waiting list and has known hepatic encephalopathy. MRI revealed hyperintense T2 signals involving the bilateral dentate nuclei, inferior colliculi and splenium of the corpus callosum, and increased diffusion restriction at the splenium of the corpus callosum. His neurological function improved over the next several days. He underwent liver transplantation 6 days after admission. A follow-up MRI 6 weeks after presentation revealed resolution of abnormalities; however, paresthesias persisted 6 months after MIE diagnosis. Conclusion. An ESLD patient with hepatic encephalopathy developed MIE after a relatively short course of metronidazole. Metronidazole has been shown to accumulate in patients with ESLD. Increased awareness for neurotoxicity when using metronidazole in ESLD patients is warranted, especially in those with potentially confounding hepatic encephalopathy. John P. Knorr, Imran Javed, Neha Sahni, Ceylan Z. Cankurtaran, and Jorge A. Ortiz Copyright © 2012 John P. Knorr et al. All rights reserved. Wed, 12 Dec 2012 09:57:14 +0000 http://www.hindawi.com/crim/hepatology/2012/132345/ During the course of acute viral hepatitis, some functional and anatomical changes to the gallbladder can occur. Acute acalculous cholecystitis (ACC) is a rare complication of acute hepatitis B virus infection; only few cases are reported as ACC associated with acute hepatitis B virus infection. ACC cases are self-limiting, while other limited cases can progress to a gangrenous state, perforation, and even death. We present a 27-year-old female case diagnosed to have acute acalculous cholecystitis and associated with acute hepatitis B virus infection, and she recovered within one week of her presentation without complication or surgical intervention. Riyadh Ali Mohammed, Wisam Ghadban, and Osama Mohammed Copyright © 2012 Riyadh Ali Mohammed et al. All rights reserved. Thu, 01 Nov 2012 10:51:58 +0000 http://www.hindawi.com/crim/hepatology/2012/298957/ Biliary cystadenocarcinomas are rare tumors that are poorly understood. Preoperative imaging is imprecise and treatment is not standardized. We describe the presentation and treatment of one of these rare tumors and review the limited published literature. Neal Wilkinson Copyright © 2012 Neal Wilkinson. All rights reserved. Thu, 18 Oct 2012 11:25:28 +0000 http://www.hindawi.com/crim/hepatology/2012/606108/ We report a rare case of resected hepatic AML, which was misdiagnosed as hepatocellular carcinoma in a chronic hepatitis B carrier. A 45-year-old woman who was a carrier of hepatitis B virus infection presented with a hepatic tumor. Her serum alpha-fetoprotein level was normal. Ultrasonography revealed a round and well-circumscribed echogenic hepatic tumor measuring 2.5 cm in the segment VI. On contrast-enhanced computed tomography, a hypervascular tumor was observed in the arterial phase and washing-out of the contrast medium in the portal phase and delayed phase. On MR T1-weighted in-phase images, the mass showed low signal intensity, and on out-of-phase images, the mass showed signal drop and dark signal intensity. On MR T2-weighted images, the mass showed high signal intensity. The mass demonstrated high signal intensity on arterial phase after contrast injection, suggestive of hepatocellular carcinoma. The patient underwent hepatic wedge resection and histopathological diagnosis was a hepatic angiomyolipoma. Jin Yeon Hwang, Sung Wook Lee, Yang Hyun Baek, Jong Han Kim, Ha Yeon Kim, Suck Hyang Bae, Jin Han Cho, Hee Jin Kwon, Jin Sook Jeong, Young Hoon Roh, and Sang Young Han Copyright © 2012 Jin Yeon Hwang et al. All rights reserved. Thu, 11 Oct 2012 08:42:24 +0000 http://www.hindawi.com/crim/hepatology/2012/728172/ Assessment of liver stiffness (LS) by transient elastography (Fibroscan) has significantly improved the noninvasive diagnosis of liver fibrosis. We here report on a 55-year-old patient with drastically increased LS due to previously unknown systemic mastocytosis. The patient initially presented with increased weight loss, nocturnal pruritus, increased transaminases, bilirubinemia, and thrombocytopenia. Abdominal ultrasound showed ascites, hepatomegaly, and splenomegaly. In addition, LS was 75 kPa (IQR 0 kPa) clearly exceeding the cut-off value for F4 cirrhosis of 12.5 kPa. However, histological analysis of the liver specimen indicated liver involvement by systemic mastocytosis and excluded liver cirrhosis. An additional CT scan detected disseminated bone lesions. After three months of treatment with Midostaurin, LS slightly decreased down to 31.9 kPa (IQR 8.3 kPa). This case illustrates that diffused sinusoidal neoplastic infiltrates are a pitfall in the non-invasive diagnosis of liver cirrhosis. In conclusion, refined clinical algorithms for increased LS should also include mastocytosis in addition to inflammation, congestion, and biliary obstruction. Stefanie Adolf, Gunda Millonig, Helmut Karl Seitz, Andreas Reiter, Peter Schirmacher, Thomas Longerich, and Sebastian Mueller Copyright © 2012 Stefanie Adolf et al. All rights reserved. Thu, 27 Sep 2012 07:58:20 +0000 http://www.hindawi.com/crim/hepatology/2012/519741/ We present the case of a 54-year-old gentleman who presented with abdominal distension and a CT scan of his abdomen revealed a large (25 cm) left hepatic lobe tumor. He received chemotherapy for over 1.5 years. The CT scans at the completion of this therapy revealed that the tumor had actually slightly grown in size. He underwent orthotopic liver transplantation without any major complications. The explant histopathology revealed an undifferentiated embryonal cell sarcoma (UECS) composed of relatively bland spindled cells arranged in short fascicles. It is now 10 years and 3 months since his last transplant and the patient remains well with no tumor recurrence. Renumathy Dhanasekaran, Alan Hemming, Elaine Salazar, and Roniel Cabrera Copyright © 2012 Renumathy Dhanasekaran et al. All rights reserved. Mon, 03 Sep 2012 15:54:48 +0000 http://www.hindawi.com/crim/hepatology/2012/793963/ This case report exhibits a rare biliary tumor within the liver of a 53-year-old Caucasian woman. This exophytic, multicystic, 6.5 × 5.0 cm mass was composed of complex tubulocystic structures lined by nonmucin-secreting, biliary epithelium embedded in fibrous stroma, consistent with biliary adenofibroma. This is the seventh case described in the literature. Multiple foci of high-grade dysplasia/carcinoma in situ were found with a microscopic focus of invasive carcinoma in review of the pathology, making this only the second case reporting malignant transformation. It is presented to illustrate the premalignant potential in a biliary epithelial tumor currently categorized as benign. N. Thao T. Nguyen, Theresa R. Harring, Laurie Holley, John A. Goss, and Christine A. O'Mahony Copyright © 2012 N. Thao T. Nguyen et al. All rights reserved. Mon, 03 Sep 2012 14:15:45 +0000 http://www.hindawi.com/crim/hepatology/2012/817314/ We present two cases of hepatic abscesses that mimicked metastases in patients having undergone Whipple surgery. Both patients had similar imaging features on computed tomographic (CT) scan and ultrasound, and at the time of referral for biopsy neither patient was clinically suspected to have liver abscess. Both patients underwent biopsy of liver lesions and developed postprocedural infectious complications. Kan K. Zhang, Majid Mayody, Rajesh P. Shah, Efsevia Vakiani, George I. Getrajdman, Lynn A. Brody, and Stephen B. Solomon Copyright © 2012 Kan K. Zhang et al. All rights reserved. Thu, 31 May 2012 13:57:39 +0000 http://www.hindawi.com/crim/hepatology/2012/135146/ Lyprinol, the lipid extract of the green-lipped mussel (Perna canaliculus), is a readily and freely available agent with a putative anti-inflammatory impact. It has already found application as a complementary and supplementary treatment of osteoarthritis, rheumatoid arthritis, asthma, and cancer. So far no major side effects for Lyprinol have been reported, yet. Here, we present the case of a 76-year-old woman with acutely exacerbating abdominal pain and highly elevated liver transaminases while taking Lyprinol as a complementary treatment of polyarthrosis. Amr Abdulazim, Marion Hädrich, Matteo Montani, and Nasser Semmo Copyright © 2012 Amr Abdulazim et al. All rights reserved. Tue, 20 Mar 2012 16:08:53 +0000 http://www.hindawi.com/crim/hepatology/2012/138381/ Two patients are presented with severe jaundice, due to inoperable cholangiocarcinoma. The chemotherapeutic approach in patients with severe jaundice is discussed. Many schedules of chemotherapy were developed in this tumor type with normal serum bilirubin. We report here the first successful use of cisplatin and gemcitabine combination chemotherapy in these patients. Tolerability was good and liver function tests gradually improved. Maarten Criel, Filip Geurs, Siegfried Ponette, Katrien Bulte, and Johan Ponette Copyright © 2012 Maarten Criel et al. All rights reserved. Sun, 15 Jan 2012 14:51:20 +0000 http://www.hindawi.com/crim/hepatology/2011/603757/ Acute liver failure (ALF) is a rare presentation of liver metastases. Although cases of ALF from metastatic disease have been reported, etiologies have been largely confined to lymphoma, metastatic breast, lung, and gastric cancers. ALF from medullary thyroid cancer (MTC) has never been reported. We present a 59-year-old male with newly diagnosed MTC, who was admitted with ALF. He presented with jaundice, hepatic encephalopathy, and synthetic dysfunction. His clinical course was marked by rapid decompensation within 6 days from initial presentation of jaundice to development of hepatic coma. Although liver metastases from medullary thyroid cancer have been reported, to our knowledge, this is the first described case of MTC resulting in acute liver failure. Emmanuel C. Gorospe and Jemilat Badamas Copyright © 2011 Emmanuel C. Gorospe and Jemilat Badamas. All rights reserved. Wed, 11 Jan 2012 15:00:55 +0000 http://www.hindawi.com/crim/hepatology/2011/314231/ Azithromycin, a semisynthetic macrolides, is frequently prescribed for the treatment of middle ear and upper respiratory tract infections, bronchitis, and community-acquired pneumonia. This antibiotic is usually well tolerated, and a rapid resolving cholestatic hepatitis has been described up to now only in six patients all, except one, over 65 years of age. We here report the case of a prolonged cholestatic hepatitis after administration of azithromycin in a young woman with no history of liver disease. Caterina Maggioli, Luca Santi, Giacomo Zaccherini, Vittoria Bevilacqua, Francesca Giunchi, and Paolo Caraceni Copyright © 2011 Caterina Maggioli et al. All rights reserved. Thu, 22 Dec 2011 09:02:31 +0000 http://www.hindawi.com/crim/hepatology/2011/276402/ Fluorodeoxyglucose positron emission tomography (18FDG-PET) is currently the best noninvasive test to confirm hepatic metastases when diagnostic uncertainty exists after initial imaging with first-line modalities. However, we report the second case of “false-positive” uptake of 18FDG on PET scanning from a histopathologically confirmed hepatic adenoma. J. A. Stephenson, T. Kapasi, O. Al-Taan, and A. R. Dennison Copyright © 2011 J. A. Stephenson et al. All rights reserved. Tue, 20 Dec 2011 10:29:49 +0000 http://www.hindawi.com/crim/hepatology/2011/329491/ We present a case of a 70-year-old patient with hepatocellular carcinoma treated with RFA. The lesion was located in segment II under the ribs. During RFA pleural effusion is presented. After the procedure a dual phase CT revealed haemothorax and extravasation of the contrast medium from the intercostal vessels. Paraskevi Tsagouli, Mary Pomoni, Savvas Tanteles, Anastasia Pomoni, and Loukas Thanos Copyright © 2011 Paraskevi Tsagouli et al. All rights reserved. Sun, 18 Dec 2011 10:17:31 +0000 http://www.hindawi.com/crim/hepatology/2011/936867/ Wild mushroom poisoning from the genus Amanita is a medical emergency, with Amanita phalloides being the most common offender. Patients may complain of nausea, vomiting, diarrhea and/or abdominal pain. If not aggressively treated, fulminant hepatic failure may develop within several days of ingestion. In this case report, a patient poisoned with Amanita bisporigera is described, along with the typical clinical presentation, patient outcomes, and treatment options for dealing with an Amanita mushroom poisoning. Anthony Nici and Sang Kim Copyright © 2011 Anthony Nici and Sang Kim. All rights reserved.