Andreia Albuquerque

High incidence of hepatocellular carcinoma following successful interferon-free antiviral therapy for hepatitis C associated cirrhosis

Please cite this article as: Cardoso, H., Vale, A.M., Rodrigues, S., Gonçalves, R., Albuquerque, A., Pereira, P., Lopes, S., Silva, M., Andrade, P., Morais, R., Coelho, R., Macedo, G., High incidence of hepatocellular carcinoma following successful interferon-free antiviral therapy for hepatitis C associated cirrhosis, Journal of Hepatology (2016), doi: http://dx.doi.org/10.1016/j.jhep.2016.07.027

Epstein-Barr virus in inflammatory bowel disease-correlation with different therapeutic regimens.

Background: Inflammatory bowel disease (IBD) is associated with a higher prevalence of opportunistic infections. Epstein–Barr virus (EBV) is a ubiquitous virus related to several malignancies, namely lymphoma; its prevalence in patients with IBD and its relation with different therapeutic regimens are not well studied. Methods: Patients followed in our IBD outpatient clinic were consecutively enrolled for participation in a prospective study, and healthy volunteers were recruited as controls. EBV DNA was measured at least 1 time in each patient. Results: Three hundred and seventy-nine individuals were enrolled in the study (93 treated with 5-aminosalicylates, 91 with azathioprine, 70 with infliximab, 43 with combined treatment with infliximab and azathioprine, and 82 controls). More than 90% of the patients had previous EBV exposure. EBV DNA was found in 132 samples (35%); its prevalence was significantly higher in every group of patients with IBD, comparing to controls. Among patients with IBD, infliximab with or without azathioprine was related to higher prevalence of EBV comparing to azathioprine alone or 5-aminosalicylates (P < 0.05). Age above 60 years was related to EBV DNA positivity with a specificity of 92%. Concerning treated groups, ulcerative colitis was the only risk factor identified for high levels of EBV DNA (>1000 and 2500 copies per milliliter). No relationship was found between EBV and C-reactive protein. Conclusions: IBD is a risk factor for the presence of EBV DNA in blood, particularly in older patients and in those taking infliximab. C-reactive protein was not related to EBV DNA prevalence.

Metastatic cutaneous Crohn's disease of the face: a case report and review of the literature

Metastatic cutaneous Crohns disease is one of the most uncommon cutaneous extraintestinal manifestations. The face is the rarest location, with only eight cases described in the literature. We report a rare case of a young man with Crohns disease and two granulomatous lesions on the face in a nodular form. To the best of our knowledge, this is the first report of metastatic Crohns disease of the forehead with the features of nodules. A review of the literature concerning metastatic Crohns disease is also provided.

Oral Lichen Planus in IBD Patients: A Paradoxical Adverse Effect of Anti-TNF-α Therapy

Introduction and aimsThe efficacy of tumor necrosis factor alpha (TNF-α) inhibitors in the treatment of Inflammatory Bowel Disease (IBD) is well established. Many cutaneous and mucosal lesions have been described under anti-TNF-α therapy, some of them being considered as paradoxical. In this series we aimed to review the cases of oral lichen planus (OLP) in IBD patients under treatment with anti-TNF-α agents.MethodsHistologic findings from oral lesions of IBD patients treated with anti-TNF were revised.ResultsThree female patients with IBD developed oral lichen planus (OLP) after starting anti-TNF-α therapy. Other etiologies were excluded.ConclusionsIn light of the increasing use of TNF-α inhibitors the occurrence of OLP is a potentially emerging side effect, thus we recommend a careful monitoring for oral manifestations in IBD patients treated with anti-TNF-α agents.

Familial Occurrence of Nodular Regenerative Hyperplasia of the Liver

To the Editor: A 42-year-old woman with asthenia and weight loss was diagnosed with pancytopenia and splenomegaly in 1996, without other relevant findings in blood tests or abdominal ultrasound. She was submitted to splenectomy and surgical liver biopsy. Histology revealed a fibrocongestive spleen, and a liver biopsy was reported as having a normal structure. After splenectomy, there was a complete normalization of the blood parameters.

Spontaneous bacterial empyema in a cirrhotic patient due to Clostridium perfringens: Case report and review of the literature

We report a case of a cirrhotic patient who developed a spontaneous bacterial empyema due to Clostridium perfringens. To our knowledge, only two cases of spontaneous bacterial empyema due to C. perfringens in cirrhotic patients were previously reported in literature. It should be suspected in a Child C cirrhotic patient, with a previous history of pleural effusion, fever and dyspnea. It has a fatal outcome as far as it has been described.

Vibrio cholerae non-O1 and non-O139 bacteremia in a non-traveler Portuguese cirrhotic patient: First case report

Bacteremia due to Vibrio cholerae non-O1 and non-O139 is a rare condition and potentially fatal. We report a case of bacteremia due to V. cholerae non-O1 and non-O139 in a Portuguese male with Hepatitis C cirrhosis, admitted due to acute diarrhea, after consuming shrimp. He had no recent travels. To our knowledge, this is the first reported case of bacteremia due to V. cholerae non-O1 and non-O139 in Portugal.

Liver abscess of the caudate lobe due to Staphylococcus aureus in an ulcerative colitis patient: First case report

Liver abscesses are very rare complications of ulcerative colitis, with only nine cases described in the literature, to our knowledge. We report a case where a recurrence of liver abscess occurred in an ulcerative colitis patient, in two different hepatic lobes, which has not been previously described. The recurrence was in the caudate lobe having the cultures yielded Staphylococcus aureus. This is also the first case report of liver abscess in this location and caused by this microorganism in an ulcerative colitis patient. A review of the literature concerning liver abscesses involving ulcerative colitis patients is also provided.

Hepatobiliary and Pancreatic: Terry's nails and liver disease

In 1954, Dr R Terry, writing in The Lancet, described a nail abnormality characterized by a white nail bed with a distal band, 1–2 mm in length, that had a normal pink color. Associations were noted with a variety of disorders including chronic liver disease. Subsequent studies confirmed an association with cirrhosis but also showed associations with congestive cardiac failure, diabetes mellitus and advanced age. There was no apparent relationship to anemia or hypoalbuminemia. Histological studies of the nail bed have shown vascular changes (telangiectasias) in the proximal and distal bands but reasons for the color variations remain unclear. One possibility is that the proximal and distal nail bed have separate blood supplies. The disorder needs to be distinguished from leukonychia (white nails) that appear to be related to minor injuries to the nail during growth. In contrast to Terry’s nails, patchy leukonychia is lost as the nail grows distally. A middle-aged male was referred to our hospital in 1997 because of minor changes in liver enzymes. He was noted to have unusual fingernails (Figure 1) and toenails (Figure 2). Apparently, these changes had been present since the age of 6 years. The proximal nail bed was white, the lunula was absent and the distal nail had a normal pink color. The features were typical of Terry’s nails. He was positive for HBsAg and antiHBe with HBV DNA levels >10 copies/ml. His serum albumin was within the reference range and he was negative for other hepatitis viruses. A liver biopsy showed mild liver inflammation without fibrosis. He was initially treated with lamivudine and subsequently with the combination of lamivudine and adefovir. Currently, he has normal liver function tests with undetectable levels of HBV DNA. A Fibroscan value was within the reference range. Terry’s nails would appear to be an uncommon feature of hepatitis B and is rare in patients without cirrhosis such as the patient described above. In patients with Terry’s fingernails, 50% of patients show similar changes in all nails but some have normal and abnormal nails, apparently in a random fashion. The frequency of the association between Terry’s fingernails and Terry’s toenails remains unclear.

Dysplasia surveillance in an ulcerative colitis patient: successful detection with narrow band imaging and magnification.

One of the contemporary challenges gastroenterologists face is cancer screening and surveillance in long-term colitis patients. The search for a consensually practical and effective method to routinely detect dysplastic mucosa persists. In recent years, publications demonstrating the applicability of narrow band imaging (NBI) in this setting have sparked further research. We present a case report where NBI with magnification played a fundamental role in the detection of dysplasia in an ulcerative colitis patient. This case reinforces the potential widespread applicability of NBI as a surveillance tool in distinguishing dysplastic from nondysplastic colorectal lesions in ulcerative colitis.