Allopurinol hypersensitivity syndrome as a cause of hepatic fibrin-ring granulomas

Vanderstigel, Muriel; Zafrani, Élie Serge; Lejonc, J. L.; Schaeffer, A; Portos, J L

doi:10.1016/0016-5085(86)90092-2

Cited by 58 publications

(16 citation statements)

References 19 publications

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“…After excluding viral and autoimmune causes, our patient's initial presentation was presumed to be due to the administration of allopurinol. Allopurinol can induce a hypersensitivity reaction 2–6 weeks after its initiation, as well as different forms of liver injury including reactive hepatitis, granulomatous hepatitis or fulminant liver failure . Despite the resolution of her liver injury and cessation of allopurinol, our patient developed another episode of acute liver injury with repeated liver biopsy showing giant cell hepatitis and portal lymphoid infiltrate indicative of CLL.…”

Section: Discussionmentioning

confidence: 81%

Syncytial giant cell hepatitis in a patient with chronic lymphocytic leukemia

Gupta

Njei

2015

J of Digest Diseases

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While it commonly occurs in the pediatric population, syncytial giant cell hepatitis is rare in adults, which is diagnosed histologically by the presence of multinucleated cells in the liver. The literature has recorded only approximately one hundred cases in adults during the past two decades in whom malignancy is rarely associated with giant cell hepatitis. Our patient is a 66-year-old woman who was diagnosed with chronic lymphocytic leukemia (CLL) and subsequently developed syncytial giant cell hepatitis. This disease is usually linked to virus infection, autoimmune diseases, and drug medications. The association between CLL and giant cell hepatitis is rare, with only three cases reported. In most cases viral particles on electron microscopy are reported and the patients usually have a history of chemotherapy and hypogammaglobulinemia. Unlike such cases, our patient developed giant cell hepatitis in the absence of such confounding variables. The treatment for our patient was a high-dose corticosteroid and rituxan, with improvement in liver enzymes.

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Section: Discussionmentioning

confidence: 81%

Syncytial giant cell hepatitis in a patient with chronic lymphocytic leukemia

Gupta

Njei

2015

J of Digest Diseases

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“…Although this type of granuloma is thought to be characteristic of Q fever hepatitis [7], it is not pathognomic. It has also been described in patients with leishmaniasis, infectious mononucleosis, giant-cell arthritis, and allopurinol hypersensitivity [8][9][10][11]. Furthermore, it has also recently been reported in acute hepatitis A and in chronic hepatitis C [12,13].…”

Section: Discussionmentioning

confidence: 89%

A Case of Acute Q Fever Hepatitis Diagnosed by F-18 FDG PET/CT

Baek

Lee

et al. 2012

Nucl Med Mol Imaging

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A 53-year-old man with fever of unknown origin underwent F-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT) as a workup for a fever of unknown origin. On presentation, he complained of fever, chills, and myalgia. The F-18 FDG PET/CT scan showed diffusely increased uptake of the liver with mild hepatomegaly. A liver biopsy then revealed fibrin-ring granulomas typically seen in Q fever. The patient was later serologically diagnosed as having acute Q fever as the titers for C. burnetii IgM and IgG were 64:1 and 16:1, respectively. He recovered completely following administration of doxycycline. This indicates that F-18 FDG PET/CT may be helpful for identifying hepatic involvement in Q fever as a cause of fever of unknown origin.

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“…These granulomas are thought to be characteristic of Q fever hepatitis 12. Also, clear central space with fibrinoidring type graulomas have also been described in patients with leishmaniasis, infectious mononucleosis, giant cell arteritis, and allopurinol hypersensitivity 13-16. Recently, it has been noted in chronic hepatitis C and acute hepatitis A 17,18.…”

Section: Discussionmentioning

confidence: 96%

A Case of Acute Q Fever with Severe Acute Cholestatic Hepatitis

Choi¹,

Lee²,

Kim³

et al. 2009

Gut Liver

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Minimal hepatic dysfunction can be common in acute Q fever, but severe acute cholestatic hepatitis is rarely reported. We report on a 55-year-old male with acute Q fever and severe acute cholestatic hepatitis. He complained of fever, jaundice, ascites, and restlessness on admission. A liver biopsy revealed the presence of compact fibrin-ring granulomas. Serologic titers for C. burnetii IgM and IgG were 2048:1 and 1024:1, respectively. C. burnetii DNA was detected by a nested polymerase chain reaction on the liver tissue.

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Allopurinol hypersensitivity syndrome as a cause of hepatic fibrin-ring granulomas

Cited by 58 publications

References 19 publications

Syncytial giant cell hepatitis in a patient with chronic lymphocytic leukemia

Syncytial giant cell hepatitis in a patient with chronic lymphocytic leukemia

A Case of Acute Q Fever Hepatitis Diagnosed by F-18 FDG PET/CT

A Case of Acute Q Fever with Severe Acute Cholestatic Hepatitis

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