Maja Ruzic

Chronic Hepatitis C and Alcohol Abuse: The Single Center Experience of Novi Sad - Serbia

BACKGROUND Chronic ethyl alcohol consuming is well known independent negative predictor of unfavorable natural course and therapy outcome of Chronic Hepatitis C (CHC) infection. OBJECTIVE The aim of the present study was to clarify the impact of alcohol consumption on fibrosis rate progression in patients with CHC and Sustained Virologic Response (SVR) rates in patients undergoing treatment with pegylated interferon and ribavirin. METHOD This cross sectional retrospective study included 807 CHC patients underwent liver biopsy and hospitalized at Clinical center of Vojvodina, Novi Sad, Serbia. According to the alcohol consumption equal or greater than 50 g/day prior to liver biopsy, patients were divided into two groups. We compared demographic, clinical, virologic and histopathological markers of CHC, as well as response to antiviral therapy. RESULTS We find statistically significant difference (p=0.001) in gender, but not in age (p=0.081), estimated duration of the CHC (p=0.470) and hepatitis C genotype (p=0.545) between two groups. Among patients with CHC who consume alcohol ≥50 g/day there were significantly higher incidence of intravenous drug users (p=0.000). Binary logistic regression showed that the only independent predictors of moderate to severe fibrosis (fibrosis ≥2) were age (p=0.000) and alcohol use (p=0.027). There was not statistically significant difference in SVR rate between two groups (p=0.810). CONCLUSION We believe that this good result in treatment outcome was the consequence of proper selection of patients based primarily on regulations of Republic of Serbia on the necessity of abstinence from the use of alcohol and psychoactive substances at least one year before starting antiviral therapy.

Treatment of acute hepatitis C in breast cancer patient: a case report.

Abstract Oncologists worldwide are often dealing with hepatitis C virus positive breast cancer patients, questioning adequate chemotherapy protocol, reduction of doses, delays, or even interruptions of treatment. We present a case of a woman in stage IIIB breast cancer, who after the completion of neoadjuvant treatment developed significant increase in liver enzymes and was diagnosed positive for HCV. She was treated with interferon and after the resolving of acute liver disease continued concomitant treatment with interferon, ribavirin, docetaxel, and trastuzumab. Grade 4 neutropenia and grade 3 hepatotoxicity occurred after the third cycle of chemo and 5 months of antiviral therapy. Interferon and chemotherapy were postponed for 1 week. There are no sufficient data in order to recommend the concomitant antiviral and antineoplastic therapy. Hepatitis C virus and antiviral therapy may increase the toxicities of antineoplastic treatment. However, when lifesaving oncologic treatment is necessary, concomitant antiviral therapy can be administered with more intensive follow up.

Exercise induced rhabdomyolysis

INTRODUCTION Rhabdomyolysis is a potentially life-threatening disease, characterized by the release of intracellular calcium from skeletal muscles and can result in acute renal failure. CASE REPORT A nineteen year old boy was admitted to the Clinic for Infective Diseases of Clinical Center Novi Sad. The disease was developing gradually and the symptoms were dizziness, muscle pain and dark color of urine. Due to the pathological level of aminotransferase he was hospitalized on the fourth day of the disease beginning with a suspicious diagnosis of acute viral hepatitis. In the hospital course of the disease, a further elevation of serum aminotransferases, creatine kinase and lactate dehydrogenase were registered. Additional serological analyses were done to exclude other possible causes of acute liver lesion. In the neurological status prolonged decontraction of quadriceps muscle was detected and the electromyography was suspicious on neuromyositis. CONCLUSION Excessive muscular activity with the strenuous exercise is the leading, but very frequently overlooked, cause of rhabdomyolysis in healthy people. Excessive physical exercise may lead to elevation of the serum activity of aminotransferases and to suspicion of hepatitis.

The occurrence of liver steatosis in patients with chronic hepatitis C - the experience of the Clinical Center of Vojvodina

Background/Aim. Hepatic steatosis in patients with chronic hepatitis C occurs in about half of the cases. Its occurrence is influenced by factors of the host and viral factors and its importance lies in the fact that it reduces the success of antiviral therapy based on interferon in the treatment of chronic hepatitis C and that, associated with other factors, exacerbates liver disease. The aim of this study was to determine the prevalence and severity of steatosis in patients with chronic hepatitis C and to determine the factors that affect its occurrence. Methods. The study included 123 patients with chronic hepatitis C with diagnosis of liver steatosis made by liver biopsy and histopathological examination according to which ≥ 5% of hepatocytes was affected by fatty change. Based on the presence of steatosis, the patients were divided into two groups: 43 patients with steatosis and 80 patients without steatosis. The influence of certain factors on the occurrence of steatosis was examined using standard statistical methods. Results. Liver steatosis was found in 34.96% of patients with chronic hepatitis C, and a majority of patients (76.74%) had mild steatosis. Of the examined predictive factors for the occurrence of steatosis, statistical significance in its occurrence was connected to elevated body mass index (BMI), genotype 3 hepatitis C virus (HCV) and HCV viremia. Conclusion. Hepatic steatosis often occurs in people with chronic hepatitis C, and most often it is mild. The occurrence of hepatic steatosis in our sample was most often affected by genotype 3 HCV and HCV viremia level. Hepatic steatosis can reduce the success of antiviral therapy based on interferon and negatively affect chronic liver disease course. Therefore, we need to recognize it, treat it and make it withdraw.

Autoimmune thyroid diseases in patients with chronic hepatitis C treated by pegylated interferon-alpha and ribavirin: A prospective study

Maja Ružić1, Milotka Fabri1, Milica Medić-Stojanoska2, Ivana Bajkin2, Vesna Turkulov1, Ludovico Abenavoli3 1University of Novi Sad, Medical Faculty, Clinical Centre of Vojvodina, Clinic for Infectious Diseases, Novi Sad, Serbia; 2University of Novi Sad, Medical Faculty, Clinical Centre of Vojvodina, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Novi Sad, Serbia; 3University “Magna Græcia”, Department of Health Sciences, Catanzaro, Italy

Rhabdomyolysis and influenza a (H3N2) infection: A case report

Influenza causes respiratory tract diseases with acute respiratory distress syndrome (ARDS) as the leading and most severe life threatening complication. In terms of early diagnosis, extrapulmonary complications are less common, but clinically a significant problem [1]. In the territory of Vojvodina, influenza occurs in epidemic forms, usually in the winter months. The most common cause is the virus Influenza A. In the season 2014/2015, the dominant type was A/H3N2. Pulmonary complications were the most common complications, and also the most common cause of death [2, 3]. However, we are witnessing the appearance of other rare and often unrecognized, life threatening complications. Rhabdomyolysis (RM) is the destruction of skeletal muscle followed by the release of intracellular myofibrils into the bloodstream and extracellular fluid. Clinical manifestations vary, from asymptomatic to life threatening conditions, such as acute renal failure and disseminated intravascular coagulation [4]. Although myositis is the most common symptom of the flu syndrome, the development of RM is rare, and it is more likely to occur in individuals with a genetic predisposition. The aim of this paper is to highlight RM as a potentially life threatening complication of influenza. Summary Introduction. Extrapulmonary complications of influenza infections are often unrecognized. The aim of this paper is to point to rhabdomyolysis as a potentially life threatening complication of influenza. Case Report. A month after the onset of influenza complicated by bronchopneumonia, the general condition of a nineteen year old female deteriorated with development of progressive muscle weakness and dark-colored urine. Despite intensive hydration and antibiotic therapy, her condition got worse, laboratory findings showed pancytopenia, hypoalbuminemia and creatine phosphokinase about 1000 times higher than normal. Influenza A H3N2 was confirmed by polymerase chain reaction analysis of the throat swab sample. Electromyoneurography showed severe acute polyneuropathy of muscles innervated by perineal nerve and signs of polymyositis; pathohistological examination of gastrocnemius muscle biopsy sample confirmed chronic myositis with necrotic neurogenic atrophy. In spite of intense hydration, the patient’s status continued deteriorating, so methylprednisolone was administered. Six weeks later, the patient was discharged in a good general condition, with blood test results within reference ranges, with weakness of foot dorsiflexors and tilting of the pelvis to the left during verticalization. Conclusion. Rhabdomyolysis caused by influenza-A is on the increase, and given the degree of morbidity and mortality, thorough assessment of patients is necessary.

Non-cirrhotic Portal Hypertension Associated with Didanosine and Streptococcus agalactiae Infection: A Case Report

BACKGROUND Non-Cirrhotic Portal Hypertension (NCPH) is a rare but potentially fatal liver disorder described in patients treated with anti-retroviral therapy for Human Immunodeficiency Virus (HIV). In particular, the most important predisposing factor to its development has been identified as prolonged exposure to Didanosine (ddI). The clinical entity of NCPH is characterized by an increase in portal pressure due to pre- or intra-hepatic causes, in absence of liver cirrhosis. However, the exact pathogenesis remains poorly understood, and due to its rarity, the diagnosis is often delayed. OBJECTIVE We herein report a case in which ddI administration, with concomitant spontaneous bacterial peritonitis by Streptococcus agalactiae, has induced NCPH in a HIV male patient. CONCLUSION NPCH should be suspected when HIV patient with an history of ddI treatment presents liver decompensation.

Visceral leishmaniasis as a cause of postpartum pyrexia — case report

IntroductionVisceral leishmaniasis, caused by protozoan parasites of the Leishmania genus, is very rare cause of postpartum pyrexia. It is also known as kala-azar, black fever, and Dumdum fever. Signs and symptoms include fever, weight loss, mucosal ulcers, fatigue, anemia, and substantial swelling of the liver and spleen.Case reportWe represent a very rare case of the septic form of visceral leishmaniasis in a thirty-year-old woman during puerperium, 31 days after vaginal delivery. Her continuously febrile state, splenomegaly, and laboratory findings characteristic of a febrile state meant that the disease at the beginning was understood and treated as a puerperal sepsis. The patient’s condition worsened continuously, despite treatment with wide spectrum antimicrobial agents. Expert advice at the Clinic decided that hysterectomy was necessary. After a short remission, her febrile state returned; we decided to transfer the patient to the Clinic for Infectious Diseases for further evaluation and diagnosis. Microscopic analyses of a sternal biopsy showed polymorphic forms of Leishmania chagasi, confirming the diagnosis of visceral leishmaniasis. After adequate the patient recovered completely.ConclusionOnly careful examination, close observation, and prompt treatment performed by a multidisciplinary team of specialists can lead to a good outcome for the patient. Bone marrow biopsy remains the gold standard in the diagnosis of Visceral leishmaniasis.

Hepatitis B reactivation after therapy for non-Hodgkin lymphoma: A case report with review of literature

The natural course of hepatitis B virus (HBV) infection depends on the immune status of the host. In cancer patients, as the consequence of immune suppression due to chemotherapy and malignant disease itself, the balance between replicative potential of the virus and immune response of the host is disrupted leading to acute HBV infection or reactivation. We present a case of HBsAg positive, diffuse large B cell gastric lymphoma patient CD20+ staged IB, treated with six cycles of R-CHOP protocol and two cycles with rituximab monotherapy. Five months after the successful anticancer treatment, patient developed reactivation of chronic HBV infection (ten-fold increase in liver enzymes, HBsAg+, IgM antiHBc+, HBeAg(-), and HBV DNA 5×10 copies/ml). Antiviral therapy with lamivudine was started. Four weeks after the antiviral therapy initiation liver enzymes were in normal ranges. One year after the start of antiviral treatment HBV DNA PCR test did not detect any viral particles. The patient is in complete remission of malignant disease, and still receiving therapy with lamivudine. HBV screening in cancer patients is necessary in order to provide a prompt antiviral therapy and to prevent postponement or even cessation of planned anticancer treatment. HBsAg positive patients should start prophylactic antiviral treatment before the start of immunosuppressive treatment. Chemotherapy protocols consisting rituximab and corticosteroids significantly increase the risk of reactivation. If reactivation is diagnosed in course of chemotherapy, the therapy should be stopped and antiviral treatment should be applied as soon as possible. Treatment with lamivudine is continued at least 6 months after the chemotherapy end.