Kanzo

Case Reports

Two cases of sporadic acute hepatitis E in Mie, Japan who were infected with subgenotype 1a hepatitis E virus

Hiroshi Okano, Tadashi Maekawa, Makoto Kobayashi, Makoto Yamawaki, Jun ...

2016 Volume 57 Issue 2 Pages 81-88
Published: February 20, 2016
Released on J-STAGE: March 03, 2016

DOIhttps://doi.org/10.2957/kanzo.57.81

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In 2015, we have seen two cases of sporadic acute hepatitis E in northern and central district of Mie prefecture, Japan. Case No.1 was a 28-year-old Nepalese man and diagnosed with imported hepatitis E, while case No. 2 was a 30-year-old Japanese man, who had no history of travel abroad within one year before the disease onset and genotype 1a strain was recovered from his serum regardless of staying in Japan at the incubation period. The HEV strains recovered from these two patients were 93.2% identical to each other in the 412-nucleotide sequence within ORF2 and did not belong to the same cluster. Case No. 1 was typical imported infectious hepatitis E disease, however, case No. 2 did not have any evidence of imported infectious disease. This result suggests that genotyping of hepatitis E virus strain is necessary for a more accurate analysis even if a patient has no history of going or living abroad.

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A case of well-differentiated hepatocellular carcinoma complicated with bleeding in the tumor

Miho Kaneto, Atsushi Hiraoka, Toshihiko Aibiki, Tomonari Okudaira, Tom ...

2016 Volume 57 Issue 2 Pages 89-96
Published: February 20, 2016
Released on J-STAGE: March 03, 2016

DOIhttps://doi.org/10.2957/kanzo.57.89

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A 54-year-old Japanese man came to our hospital for examination of a hepatic tumor shown by ultrasonography performed during a medical check-up examination. A blood examination showed no abnormal findings including hepatitis viral markers (anti-HCV and HBsAg). Ultrasonography revealed a hyperechoic tumor in the 6th segment of the liver that was 4 cm in diameter. The tumor showed no vascularity in the arterial phase of contrast-enhanced CT, while fluid collection was suspected, because of low intensity in T1 and high intensity in T2 MRI findings, and no abnormal uptake of FDG in FDG-PET/CT results. Anti-parasitic antibodies were negative. The mass was resected and diagnosed as a well-differentiated hepatocellular carcinoma (HCC) complicated with bleeding in the tumor, with no underlying hepatic disease. Although, bleeding in an HCC is rare, hematoma complication should be kept in mind during examinations of such cases.

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Two cases of primary biliary cirrhosis complicated by autoimmune hepatitis at the age of over eighties

Yuuichi Ikarashi, Makiko Taniai, Etsuko Hashimoto, Kazuhisa Kodama, To ...

2016 Volume 57 Issue 2 Pages 97-105
Published: February 20, 2016
Released on J-STAGE: March 03, 2016

DOIhttps://doi.org/10.2957/kanzo.57.97

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Case 1) A 84-year old woman diagnosed as primary biliary cirrhosis (PBC) and was treated with ursodeoxycholic acid (UDCA). She was admitted to our hospital after two years of therapy cessation due to acute exacerbation of serum transaminase levels, total bilirubin level, IgG level and positivity of antinuclear antigen (ANA) and antimitochondrial antigen (AMA). She was diagnosed as hepatitis form of PBC, treated with predonisolone (PSL), revealed hepatic failure, but recovered after additional treatment with azathioprine. Her first liver specimen revealed submassive hepatic necrosis and second PBC stage 2. Case 2) A 76-year old patient diagnosed as AMA-negative-PBC and admitted 4 years later due to acute exacerbation of serum transaminase levels, IgG level and positivity of antinuclear antigen (ANA). She was diagnosed as hepatitis form of PBC due to blood test and findings of her liver specimen revealed PBC stage 2 with moderate interface hepatitis. PBC patients are at the risk of development of autoimmune hepatitis even in elderly patients.

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An elderly case of ceftriaxone-associated pseudolithiasis that developed during therapy for acute pneumonia

Kazufumi Dohmen, Asataro Yamamoto, Hirofumi Tanaka, Masatora Haruno, S ...

2016 Volume 57 Issue 2 Pages 106-112
Published: February 20, 2016
Released on J-STAGE: March 03, 2016

DOIhttps://doi.org/10.2957/kanzo.57.106

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A 76-year-old male was referred to our hospital due to symptoms of a high fever and cough. He was diagnosed to have pneumonia based on the X-ray findings and elevated white blood cell counts and CRP. Ceftriaxone (CTRX) at a dose of 2 g per day was administered. He complained of right hypochondralgia at eight days after the start of CTRX treatment. A laboratory examination showed the elavated levels of AST of 587 IU/l, ALT 311 IU/l and ALP 709 IU/l, respectively. US, CT and MRI revealed an abnormally thick gallbladder wall in addition to the presence of sludge and a stone. He was diagnosed to have CTRX-associated pseudolithiasis. His complaints and abnormal findings confirmed by CT resolved completely after the discontinuation of CTRX therapy. We should therefore be aware of the fact that the administration of CTRX may sometimes cause the formation of biliary sludge or stones which can possibly lead to the onset of adverse events, not only in children, but also in elderly patients.

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