J Korean Med Sci.  2000 Feb;15(1):111-114. 10.3346/jkms.2000.15.1.111.

Fibrosing cholestatic hepatitis: a report of three cases

• Lee HK
• Yoon GS
• Min KS
• Jung YW
• Lee YS
• Suh DJ
• Yu E

• KMID: 1731246
• DOI: http://doi.org/10.3346/jkms.2000.15.1.111

Abstract

Fibrosing cholestatic hepatitis is an aggressive and usually fatal form of viral hepatitis in immunosuppressed patients. We report three cases of fibrosing cholestatic hepatitis in various clinical situations. Case 1 was a 50-year-old man who underwent a liver transplant for hepatitis B virus (HBV)-associated liver cirrhosis. Two and a half years after the transplant, he complained of fever and jaundice, and liver enzymes were slightly elevated. Serum HBsAg was positive. Case 2 was a 30-year-old man in an immunosuppressed state after chemotherapy for acute lymphoblastic leukemia. He was a HBV carrier. Liver enzymes and total bilirubin were markedly elevated. Case 3 was a 50-year-old man who underwent renal transplantation as a known HBV carrier. One year after the transplant, jaundice developed abruptly, but liver enzymes were not significantly elevated. Microscopically lobules were markedly disarrayed, showing ballooning degeneration of hepatocytes, prominent pericellular fibrosis, and marked canalicular or intracytoplasmic cholestasis. Portal inflammation was mild, but interphase activity was definite and cholangiolar proliferation was prominent. Hepatocytes were diffusely positive for HBsAg and HBcAg in various patterns. Patients died of liver failure within 1 to 3 months after liver biopsy in spite of anti-viral treatment.

Keyword

Hepatitis B; Immunosuppression; Transplant; Cholestasis; Fibrosis; Liver Failure

MeSH Terms

Adult
Case Report
Cholestasis, Intrahepatic/virology
Cholestasis, Intrahepatic/immunology
Cholestasis, Intrahepatic/etiology*
Fibrosis
Hepatitis B/complications*
Human
Immunosuppression/adverse effects
Liver Transplantation
Male
Middle Age