Clinical courses after administration of oral corticosteroids in patients with severely cholestatic acute hepatitis A; three cases

Yoon, Eileen L.; Yim, Hyung Joon; Kim, Seung Young; Kim, Jeong Han; Lee, Ju Han; Lee, Hyun Jung; Jung, Sung Woo; Lee, Sang Woo; Choi, Jai Hyun

doi:10.3350/kjhep.2010.16.3.329

Cited by 21 publications

(11 citation statements)

References 12 publications

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“…Steroid therapy was reported to provide no improvement in the clinical manifestations of viral hepatitis among 77 patients with acute hepatitis. 11,13 In conclusion, spontaneous clinical improvement was reported in some cases with cholestatic form of the disease. 4 However, use of corticosteroids may provide rapid correction of clinical manifestations in selected non-immunocompromised patients presenting with very severe symptoms associated with cholestasis or relapsing patients with prolonged cholestatic form of the disease under close supervision.…”

Section: Discussionmentioning

confidence: 72%

“…Experimental studies on animals have shown that corticosteroids provide beneficial effects by inhibiting synthesis of inflammatory cytokines and improving actions of mrp2. 11,12 For our patient, use of corticosteroid was deemed necessary due to a significantly elevated level (48 mg/dL) of total bilirubin (direct bilirubin 33.86 mg/dL) before steroid treatment, persistence of bilirubin elevations and particularly the presence of severe itching. It is interesting to note that Yoon et al reported three patients who started treatment with oral prednisolone at a dose of 30 mg/day despite having much lower levels of direct bilirubin (19, 27 and 31 mg/dL, respectively).…”

Section: Discussionmentioning

confidence: 99%

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Use of steroids for prolonged cholestasis secondary to acute hepatitis A infection

Pullukçu¹

2014

Jmid

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Hepatit A is usually a self-limited, asymptomatic infection. However, severe manifestations of hepatitis may occur rarely in adult patients. Here, we present a case of prolonged, relapsed cholestasis secondary to acute hepatitis infection in an adult patient. A 25-year old male patient had been given symptomatic treatment for weakness, abdominal pain, loss of appetite, pruritis, nausea and generalized jaundice. A week later, he had been diagnosed with acute hepatitis A infection. He admitted to our clinic two months after the first episode with complaints of pruritis and jaundice. His laboratory results included a serum alanine aminotransferase (ALT) level of 86 U/L, aspartate transferase (AST) of 91 U/L, total bilirubin of 46.5 mg/dl and direct bilirubin of 33.9 mg/dl. ursodeoxycholic acid (UDCA) therapy was started due to protracted jaundice, severe itching and a marked elevation in bilirubin levels, which was replaced with prednisolone therapy at a dose of 1 mg/kg/day at 12 days. Most of his clinical symptoms resolved with much lower serum bilirubin levels. No clinical or biochemical deterioration was observed after discontinuation of therapy. One year later his general condition was good with no relapse. There are few case reports in literature about the use of corticosteroids for treatment of prolonged cholestatic jaundice in patients with hepatitis A infection. Based on our findings, we suggest that this type of therapy may be beneficial for relief of symptoms and improvement of serum biochemistry.

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Use of steroids for prolonged cholestasis secondary to acute hepatitis A infection

Pullukçu¹

2014

Jmid

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“…The exchange of nucleotides in the mid-section of the untranslated sector 5 may also intervene with the severity of the damage [1]. In addition, cytokines and other inflammatory promoters like TNF-α and IL1 play a role in causing cholestasis [2, 4].…”

Section: Discussionmentioning

confidence: 99%

Two case reports of corticosteroid administration-prolonged and pulsed therapy-in treatment of pruritus in cholestatic hepatitis A patients

Daghman

Rez

Soltany

et al. 2019

Oxford Medical Case Reports

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Cholestasis following hepatitis A affects around 0.8% of hepatitis A patients. It is considered a distressing complication in spite of its good prognosis. Despite being subject to multiple studies, causes of cholestasis are still controversial. Many treatments (discussed later) have shown some improvements of the accompanied pruritus. In the following article, we present two cholestatic hepatitis A patients who suffered from severe pruritus. Prednisolone was administered via two different methods: prolonged and pulsed. Both showed great improvement of the pruritus in a short time frame. To the best of our knowledge, our management using pulsed corticosteroid therapy in treatment of pruritus in cholestatic hepatitis A is considered the first experimental management in medical literature. The importance of this experimental case lies in reducing the doses and the duration of steroid intake, thus reducing steroid side effects as far as possible.

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“…Two children, who presented with higher total bilirubin values (patients 2 and 14) (Table 1), received a brief course of steroid therapy, with prompt reduction of hyperbilirubinemia (Yoon et al, 2010;Saboo et al, 2012).…”

Section: Discussionmentioning

confidence: 99%

High prevalence of gallbladder involvement during hepatitis: An outbreak in a paediatric population

Vita¹,

Tebano²,

Rossomando³

et al. 2016

J. Med. Lab. Diagn.

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Acute hepatitis A (AHA) in children usually has generally benign course. In literature, there are several descriptions of gallbladder involvement in AHA, but there are few data on the pediatric population. Fifteen children living in a Romani camp or in the neighbourhoods with AHA were admitted. 57% of children who underwent abdomen ultrasounds showed a significant gallbladder involvement and none of the patients required further diagnostic exams or surgical evaluation. This high frequency of gallbladder involvement is not usually described in pediatric AHA. Furthermore, this is the first Italian AHA outbreak in Romani children population reported in medical literature.

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Clinical courses after administration of oral corticosteroids in patients with severely cholestatic acute hepatitis A; three cases

Cited by 21 publications

References 12 publications

Use of steroids for prolonged cholestasis secondary to acute hepatitis A infection

Use of steroids for prolonged cholestasis secondary to acute hepatitis A infection

Two case reports of corticosteroid administration-prolonged and pulsed therapy-in treatment of pruritus in cholestatic hepatitis A patients

High prevalence of gallbladder involvement during hepatitis: An outbreak in a paediatric population

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