PubTransformer

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PMID- 29390558
OWN - NLM
STAT- MEDLINE
DCOM- 20180212
LR  - 20180212
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 51
DP  - 2017 Dec
TI  - Course of hepatitis E infection in a patient with rheumatoid arthritis and
      autoimmune hepatitis: A case report.
PG  - e9407
LID - 10.1097/MD.0000000000009407 [doi]
AB  - RATIONALE: A 62-year-old male patient was admitted to our clinic in February 2016
      with persistently elevated liver enzymes. PATIENT CONCERNS: Clinical history
      involved a long time of poly-autoimmunity with a rheumatoid arthritis (in
      remission under tocilizumab therapy), an autoimmune thyroiditis, an eosinophilia 
      as well as a hyper-immunoglobulin (IgG) 4-syndrome. DIAGNOSES: Laboratory studies
      revealed a significant increase in liver enzymes with an alanine aminotransferase
      (ALT) level of 574 U/L and an aspartate aminotransferase (AST) level of 864 U/L
      (normal <50 U/L). Furthermore, the patient was positive for anti-nuclear
      autoantibodies (ANA) with a titer of 1:320 (normal upper limit: 1:80).
      INTERVENTIONS: Liver histology, obtained via mini-laparoscopy, demonstrated
      lobular hepatitis with markedly increased hepatocyte apoptosis, lymphoplasmatic
      cell infiltration, and 20% microvascular fat without significant fibrosis, which 
      strengthened the diagnosis of autoimmune hepatitis (AIH). Pulse steroid treatment
      with 100 mg prednisolone for 3 days followed by a tapering down was initiated.
      Follow-up laboratory analysis demonstrated a decrease in liver enzymes and also
      of the ANA-titer. OUTCOMES: At that point, hepatitis E virus (HEV) infection was 
      diagnosed with a positive anti-HEV immunoglobulin M (IgM) antibody and
      HEV-ribonucleotide acid (RNA) of 6280 copies/mL. LESSONS: Despite the HEV
      infection and due to the strength of autoimmunity, we decided to continue
      immunosuppressive therapy and monitored HEV-PCR regularly. However, HEV-RNA
      became negative after 2 months and HEV-IgM turned negative after 13 months.
CI  - Copyright (c) 2017 The Authors. Published by Wolters Kluwer Health, Inc. All
      rights reserved.
FAU - Thodou, Victoria
AU  - Thodou V
AD  - Department of Gastroenterology and Hepatology, University Clinic Essen, Germany.
FAU - Buechter, Matthias
AU  - Buechter M
AD  - Department of Gastroenterology and Hepatology, University Clinic Essen, Germany.
FAU - Manka, Paul
AU  - Manka P
AD  - Department of Gastroenterology and Hepatology, University Clinic Essen, Germany.
AD  - Division of Transplantation Immunology and Mucosal Biology, King's College,
      London, UK.
FAU - Gerken, Guido
AU  - Gerken G
AD  - Department of Gastroenterology and Hepatology, University Clinic Essen, Germany.
FAU - Kahraman, Alisan
AU  - Kahraman A
AD  - Department of Gastroenterology and Hepatology, University Clinic Essen, Germany.
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - 0 (Immunosuppressive Agents)
RN  - 9PHQ9Y1OLM (Prednisolone)
SB  - AIM
SB  - IM
MH  - Arthritis, Rheumatoid/*complications/pathology/virology
MH  - Hepatitis E/*complications/pathology
MH  - Hepatitis, Autoimmune/*complications/pathology/virology
MH  - Humans
MH  - Immunosuppressive Agents/therapeutic use
MH  - Liver/pathology
MH  - Liver Function Tests
MH  - Male
MH  - Middle Aged
MH  - Prednisolone/therapeutic use
PMC - PMC5758260
EDAT- 2018/02/03 06:00
MHDA- 2018/02/13 06:00
CRDT- 2018/02/03 06:00
PHST- 2018/02/03 06:00 [entrez]
PHST- 2018/02/03 06:00 [pubmed]
PHST- 2018/02/13 06:00 [medline]
AID - 10.1097/MD.0000000000009407 [doi]
AID - 00005792-201712220-00145 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 Dec;96(51):e9407. doi: 10.1097/MD.0000000000009407.