G. Stoppino

Primary clarithromycin resistance in Italy assessed on Helicobacter pylori DNA sequences by TaqMan real-time polymerase chain reaction

Helicobacter pylori clarithromycin resistance is increasing worldwide and different mutations are involved in its mechanisms. Recently, molecular methods have been proposed to assess these mutations.

Onset of liver damage after a single administration of infliximab in a patient with refractory ulcerative colitis.

We report the case of a patient with refractory ulcerative colitis who developed cholestatic acute liver damage after a single infusion of infliximab. Unusual aspects of this case were the early onset (after the first administration) of liver damage and the absence of antinuclear antibodies, alcohol intake, hepatotoxic drugs and all known viral and metabolic causes of hepatic injury. Moreover, no serological or morphological findings of primary sclerosing cholangitis were observed. The patient’s liver damage resolved spontaneously within 6 weeks. Although a direct relationship between administration of infliximab and onset of acute liver damage could not be definitely established, our case suggests that infliximab may induce direct liver damage, the course of which is similar to acute cholestatic hepatitis and resolves following withdrawal of the drug.

Hepatic loss in a young patient: a very ‘cold case’

Dr. De Francesco. A 28-year-old male farmer, complaining of mild, recurrent right upper quadrant and chest pain was referred to gastroenterology. The patient had received sporadic and unsuccessful NSAID-based therapy during the prior 2 years. Bowel movements were regular and no fever was present. He smoked ten cigarettes daily. Physical examination was unrewarding, but abdomen palpation revealed exacerbation of tenderness in the liver area with modest hepatomegaly. An abdominal ultrasonography was performed showing a round mass, 8 cm in diameter, localized in the right hepatic lobe, with a heterogeneous ultrasound signal in the central area. Laboratory tests found elevated levels of alanine aminotransferase (91.5 normal value), alkaline phosphatase and c-glutamyltranspeptidase (both 9 1.3 normal value) and increased values of erythrosedimentation rate (48 mm/h), C-reactive protein (95.5 normal value), cholesterol level (91.2 normal value) and triglycerides level (92 normal value); all other biochemical tests, including a-fetoprotein, were in the normal range. Computed tomography (CT scan) confirmed the presence of a round mass (11 9 10 cm) in the right hepatic lobe, compressing the right hepatic vein. The lesion appeared heterogeneous and hypodense, with a peripheral enhancement in the arterial phase and low enhancement in the portal and delayed phase. A pseudo-capsule was evident with a small interruption in the proximity of a satellite nodule of 1 cm (Fig. 1).