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

Daghman, Daad; Rez, Mohamad Saeed; Soltany, Amjad; Alsaleh, Almotaman

doi:10.1093/omcr/omz080

Cited by 5 publications

(6 citation statements)

References 10 publications

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“…Histopathological findings of liver biopsy in CVH-A in most cases show marked centrilobular cholestasis, spotty necrosis in the periportal space with interlobular bilirubin accumulation, especially in the zone 3 (3,10). Our patient refused the proposed liver biopsy.…”

Section: Discussionmentioning

confidence: 73%

“…Rifampicin and phenobarbital, which act to promote liver metabolism by stimulating cytochrome P 450 enzymes, have been suggested as possible treatment options in the literature. Antihistamines have a limited effect on relieving pruritus (3). Bile acid-binding resins, such as cholestyramine, prevent the reabsorption of bile salts from the intestines and lower cholesterol levels.…”

Section: Discussionmentioning

confidence: 99%

“…It is characterized by elevated liver enzymes and increases in blood bilirubin levels. It often has a prolonged course (12 weeks to 8 months), accompanied by imminent acute liver failure (ALF), pronounced jaundice and intractable pruritus (3). Elevated levels of cholesterol and triglycerides are also common.…”

Section: Introductionmentioning

confidence: 99%

“…Several treatments (discussed later) have been successful in relieving the accompanying pruritus. Corticosteroids have shown considerable efficacy in achieving pruritus reduction (3). Extracorporeal albumin dialysis (ECAD) procedures, such as the Molecular Adsorbents Recirculating System (MARS), are generally safe and effective to treat drug-resistant pruritus, yielding significant improvement in pruritus and having minor side effects (4).…”

Section: Introductionmentioning

confidence: 99%

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Cholestatic viral hepatitis a with refractory pruritus successfully treated with a combination of molecular adsorbent recirculating system and corticosteroids: A case report

Đorđević,

Čanović,

Petrović

et al. 2023

Acta fac medic Naissensis

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Introduction. Hepatitis A virus is a major cause of acute viral hepatitis worldwide, with approximately 1.5 million cases annually. Clinical manifestations of the hepatitis A virus infection range from asymptomatic to acute liver failure. Cholestatic viral hepatitis A is a rare clinical manifestation characterized by a prolonged course, refractory pruritus, imminent acute liver failure and generally good prognosis. The treatment of pruritus in cholestatic viral hepatitis A can be challenging because a response to conventional therapy is limited. Case report. We present the effects of a combination of pulse doses of prednisolone and two cycles of MARS (Molecular Adsorbent Recirculating System) in the treatment of a young female patient with cholestatic viral hepatitis A. This treatment option significantly reduced the duration of the disease and the intensity of pruritus and led to full recovery of the patient and normalization of laboratory parameters of cholestasis. Conclusion. This treatment combination has proven to have significant and lasting effects with no relapse of pruritus. Low doses of corticosteroids administered for a short time reduce the risk of side effects. The importance of vaccination of international travellers should be also pointed out here.

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Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cholestatic viral hepatitis a with refractory pruritus successfully treated with a combination of molecular adsorbent recirculating system and corticosteroids: A case report

Đorđević,

Čanović,

Petrović

et al. 2023

Acta fac medic Naissensis

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“…Different case reports showed an improvement in the disease after corticosteroid administration [ 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 ]. The utility of corticosteroids to prevent prolonged cholestasis after acute hepatitis A has been evaluated in several case reports and case series, where it has been reported a reduction in bilirubin levels, itching and liver injury markers [ 69 , 70 ]. Prednisone is usually started at a dose of 30–50 mg daily and tapered off at a rate of 5 mg every week.…”

Section: Hav Infection Overviewmentioning

confidence: 99%

Treatment Options for Hepatitis A and E: A Non-Systematic Review

Gabrielli

Alberti

Russo

et al. 2023

Viruses

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Hepatitis A and hepatitis E are relatively common causes of liver disease. Both viruses are mainly transmitted through the faecal–oral route and, consequently, most outbreaks occur in countries with poor sanitation. An important role of the immune response as the driver of liver injury is also shared by the two pathogens. For both the hepatitis A (HAV) and hepatitis E (HEV) viruses, the clinical manifestations of infection mainly consist of an acute disease with mild liver injury, which results in clinical and laboratory alterations that are self-limiting in most cases. However, severe acute disease or chronic, long-lasting manifestations may occur in vulnerable patients, such as pregnant women, immunocompromised individuals or those with pre-existing liver disease. Specifically, HAV infection rarely results in fulminant hepatitis, prolonged cholestasis, relapsing hepatitis and possibly autoimmune hepatitis triggered by the viral infection. Less common manifestations of HEV include extrahepatic disease, acute liver failure and chronic HEV infection with persistent viraemia. In this paper, we conduct a non-systematic review of the available literature to provide a comprehensive understanding of the state of the art. Treatment mainly consists of supportive measures, while the available evidence for aetiological treatment and additional agents in severe disease is limited in quantity and quality. However, several therapeutic approaches have been attempted: for HAV infection, corticosteroid therapy has shown outcome improvement, and molecules, such as AZD 1480, zinc chloride and heme oxygenase-1, have demonstrated a reduction in viral replication in vitro. As for HEV infection, therapeutic options mainly rely on the use of ribavirin, and some studies utilising pegylated interferon-alpha have shown conflicting results. While a vaccine for HAV is already available and has led to a significant reduction in the prevalence of the disease, several vaccines for HEV are currently being developed, with some already available in China, showing promising results.

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