Hiromi Aonuma

Colonic and peritoneal tuberculosis associated with coloduodenal fistula

We report a very rare case of tuberculous colitis that showed relatively long-segment involvement of the colon near the hepatic flexure with coloduodenal fistula that caused severe malnutrition. The formation of fistula in abdominal tuberculosis is very rare. This is the eighth reported case of abdominal tuberculosis with fistula and the first reported case with a coloduodenal fistula.

Liver sarcoidosis showing low-density intrahepatic septa on postcontrast computed tomography.

SummaryThe authors present a patient with massive liver sarcoidosis, showing only slight hepatomegaly on precontrast computed tomogram and multiple low-density intrahepatic septa on postocontrast computed tomogram. Sarcoidosis frequently involves the liver, but rarely shows abnormal findings other than hepatomegaly on computed tomograms. Only a few cases have demonstrated a low density intrahepatic area on computed tomograms1,2. In this report, we present a patient with massive liver and pulmonary sarcoidosis, showing low density intrahepatic septa and pulmonary fibrosis on computed tomograms.

Late onset hepatic failure due to hepatitis B virus with mutations in the pre-core region

A 60-year-old man complained of severe general fatigue on October 11, 1992. Pertinent laboratory findings were: aspantate aminotransferase (AST) 1920 IU, alanine aminotransferase (ALT) 2050 IU, and total bilirubin (T.Bil) 124 micromol/l (normal range, 0–17 micromol/l). Virological assay revealed that hepatitis B surface antigen (HBsAg), anti-hepatitis B e (HBe), anti-HBc, and immunoglobulin M (IgM) anti-HBc were positive, and anti-HBs, HBeAg, and anti-delta antibody were negative. A diagnosis of acute hepatitis due to hepatitis B virus was made. Despite a decrease in transaminase, jaundice worsened and prothrombin time was prolonged. On the 60th day of hospitalization, massive ascites developed, but the patients consciousness was not impaired. Although albumin and diuretics were given, the ascites further increased. Paracentesis of 2000ml of ascitic fluid was performed twice a week. On the 120th day of hospitalization, the patient passed black stools and he exhibited renal failure 3 weeks later. Although severe jaundice persisted, he was still alert. On the 150th day of hospitalization, massive gastrointestinal bleeding occurred, due to hemorrhagic gastritis. Despite receiving intensive care, the patient died. Determination of the HBV DNA sequence revealed two point mutations in the pre-core region; these have not been reported elswwhere.

A case of alcoholic liver cirrhosis with small hepatocellular carcinoma in ademonatous hyperplasia.

HCV抗体(第二世代),HCV-RNA陰性で日本酒一日6合・10年間の飲酒歴を有する若年大酒家のF型肝硬変の経過中にAdenomatous hyperplasiaを認め,脳出血で死亡し,剖検で肝細胞癌が発見された1例を経験した.患者は31歳男性.胆石の術前検査で肝機能異常を指摘された.その後の血液学検査,各種画像診断,腹腔鏡および肝生検検査にてHCV抗体陰性のF型肝硬変と診断された.この際,腹部超音波検査,腹部CT検査で肝に腫瘤性病変の存在が認められた為,狙撃生検が施行されたが,悪性所見はみられなかった.その半年後に再度肝腫瘤に対して狙撃生検が施行されるも,Adenomatous hyperplasiaの所見であった.3ヵ月後脳出血で死亡したが,剖検所見で肝左葉に4個の境界明瞭な腫瘤性病変が認められ,そのうち1個の腫瘤がEdmondson-II型の肝細胞癌を内包していた.Adenomatous hyperplasiaと肝細胞癌の関連を示唆する興味ある症例と考えられた.

A case of drug induced hepatitis due to warfarin potassium.

warfarin potassiumによる肝障害は極めて稀であり,内外で数例の報告をみるにすぎない.著者らはwarfarin potassiumによる薬剤性肝炎を経験したので報告する.症例は55歳の男性でaorto-coronary bypass術後の抗凝固療法としてwarfarin potassiumが投与され,約50日後黄疸とトランスアミナーゼおよび胆道系酵素の著明な上昇を示した.HBウイルスマーカー,IgM HA抗体は陰性で薬剤性肝障害が示唆されたため同薬剤の投与を中止したところ速やかに肝機能検査は正常となった.肝生検所見では急性肝炎回復期と診断された.warfarin potassiumによるリンパ球培養試験は陰性を示し臨床上抗凝固療法を必要としたため再度warfarin potassiumを投与したところ3日後全身倦怠感とともに肝機能検査に異常を来した.再度同剤によるリンパ球培養試験を行ったところstimulation indexは320%と陽性でwarfarin potassiumによる薬剤性肝障害と診断された.