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(118). Sarcoidosis-associated hepatitis C virus infection: Two cases
Helicobacter pylori and cancer / Arab Journal of Gastroenterology 10 (2009) AB45–AB52
(117) Association of chronic hepatitis C with mixed symptomatic ryoglobulinaemia T. Kharrasse, A. Karim, R. Alaoui, W. Hliwa, W. Badre, A. Bellabah, S. Nadir, A. Cherkaoui Gastro-Enterology Department, CHU Ibn Rochd, Casablanca, Morocco
Introduction: The extrahepatic manifestations of viral hepatitis C are various, their majority being due to mixed cryoglobulinaemia. The purpose of this work is to report an association of chronic hepatitis C with mixed symptomatic cryoglobulinaemia, and especially to estimate its evolution under antiviral treatment. Observation: We report a case of a 55 years old patient, with arterial hypertension, and liver cirrhosis due to HVC. The diagnosis of cryoglobulinaemia is suspected in front of the presence of Raynaud phenomenon with purpuric lesions of the lower limbs, and confirmed by positive serum cryoglobulin, the existence of leucocytoclastic vasculitis in a skin biopsy specimen, and the presence of nephrotic syndrome with, in the renal biopsy, membranoproliferative glomerulonephritis with parietal and mesangial deposits of IgM and IgG antibodies. The patient is treated by association of pegylated interferon and ribavirin. Evolution was marked by the disappearance of skin lesions and nephrotic syndrome. Conclusion: Association of chronic hepatitis C with mixed cryoglobulinaemia is rarely symptomatic. The appearance of clinical manifestations of cryoglobulinaemia represents an indication to antiviral treatment. doi:10.1016/j.ajg.2009.07.141
(118) Sarcoidosis-associated hepatitis C virus infection: Two cases H. Massit, N. Benzoubeir, H. Tlemsani, I. Errabih, H. Krami, L. Ouazzani, H. Ouazzani Hepatogastroenterology Unit ‘‘B, Universitary Hospital Ibn Sina, Rabat, Morocco
Background: Sarcoidosis is a multisystem granulomatous disorder of unclear etiology. Interferons (IFN) have been implicated in its pathogenesis. Most reported cases of chronic hepatitis C (HCV) associated-sarcoidosis are not the consequence of HCV infection per se, but are the results of interferon antiviral therapy. However, cases of HCV associated-sarcoidosis without interferon therapy have also been recently reported and the possibility of HCV infection per se inducing sarcoidosis by activating host immune systems has been suggested. We report two new cases of association chronic hepatitis C and sarcoidosis. Case reports: Case 1: A 54 years old woman, treated by pegylated interferon alpha and ribavirin for chronic hepatitis C (genotype 1b), She developed cutaneous and pulmonary sarcoı¨dosis about 6 months after beginning treatment. Physical examination revealed the presence of skin lesions on the legs, fore arm, and the face. A skin biopsy revealed sarcoidal type non-necrotizing granulomas in the subcutaneous tissue. Chest radiography and CT-scan showed deep lymphadenopathy. The evolution was favourable after stopping treatment. Case 2: A 50 year old woman with five years history of systemic sarcoidosis involving lung, and spleen treated with prednisolone. She was admitted for elevation of aminotransferase activity and found a chronic hepatitis C (genotype 2). Percutaneous liver biopsy found: Metavir score A1F2 and granulomas are identified, the hepatic histologic findings are compatible with those of hepatic sarcoidosis. The patient was treated by pegylated interferon alpha and
AB51
ribavirin during 6 months without virological response and she developed ocular complication. The antiviral therapy was stopped. Conclusion: There is a potential causal relationship between IFN therapy and sarcoidosis but cases of sarcoidosis and chronic hepatitis C with no history of interferon therapy are reported. Sarcoidosis must also be considered, not only during interferon therapy but also before antiviral therapy, since sarcoidosis may preclude interferon administration. doi:10.1016/j.ajg.2009.07.142
(119) Association of hepatitis C virus infection and immune thrombocytopenic purpura (a new case) F. Laayouni, N. Lakhrib, A. Karim, R. Alaoui, W. Hliwa, W. Badre, A. Bellabah, S. Nadir, A. Cherkaoui Gastro-enterology Department, Chu Ibn Rochd, Casablanca, Morocco
Introduction: Extrahepatic manifestations of viral hepatitis C (HCV) infection are multiples and frequently observed. Immune thrombocytopenic purpura (ITP) represents 10–41% of these manifestations. This association is a real therapeutic challenge. Objectives: The aim of this work is to report a new case of the association HCV infection and ITP and to highlight the therapeutic difficulties. Case report: A 51-year-old woman, with HCV infection (Metavir stage A3F4, was treated by a bitherapy PEG-INF-alpha plus Ribavirin. A severe thrombocytopenia (46.000/ml) revealed by hemorrhagic syndrome was appeared then, antiviral treatment was stopped. Biological examinations revealed an immune thrombocytopenia with positive anti-platelet antibody, thus, the diagnosis of immune thrombocytopenic purpura was considered. There was no amelioration under corticosteroids treatment, imposing its stop. The reintroduction of PEG-INF-alpha and Ribavirin has worsened thrombocytopenia. Interferon therapy was stopped, and two months later, the platelet count was normal under Ribavirin alone. Serum RNA-HCV was negative after 7 months. Conclusion: The HCV infection and ITP association is a result of the fibrotic action of the disease, it is a real therapeutic challenge which require a multidisciplinary approach involving hematologist and hematologist. doi:10.1016/j.ajg.2009.07.143
(120) Acute delirious puff during a treatment by interferon of the chronic hepatitis C (1 case) H. Sammoud, M. Tahiri, H. Elazrak, W. Badre, A. Bellabah, R. Alaoui, A. Cherkaoui Service De Gastroenterologie, CHU Ibn Rochd Casablanca, Morocco
The interferon alpha is a molecule which revolutionized the preview of the hepatitis C. However, neuropsychiatric demonstrations were observed at more than 20% of the patients treated by this molecule. The classically unwanted effect observed is the depression; however, more austere psychoses can arise. We report the observation of an old patient of 54 years without psychiatric antecedent, followed for chronic hepatitis C, genotype 1, F2 on the score of METAVIR and having begun a treatment by interferon Peg alpha 2a and ribavirine. three months after the beginning of the treatment, the patient presented the fast installation of hallucinations in type of perception of animals and strange voices,
(117) Association of chronic hepatitis C with mixed symptomatic ryoglobulinaemia T. Kharrasse, A. Karim, R. Alaoui, W. Hliwa, W. Badre, A. Bellabah, S. Nadir, A. Cherkaoui Gastro-Enterology Department, CHU Ibn Rochd, Casablanca, Morocco
Introduction: The extrahepatic manifestations of viral hepatitis C are various, their majority being due to mixed cryoglobulinaemia. The purpose of this work is to report an association of chronic hepatitis C with mixed symptomatic cryoglobulinaemia, and especially to estimate its evolution under antiviral treatment. Observation: We report a case of a 55 years old patient, with arterial hypertension, and liver cirrhosis due to HVC. The diagnosis of cryoglobulinaemia is suspected in front of the presence of Raynaud phenomenon with purpuric lesions of the lower limbs, and confirmed by positive serum cryoglobulin, the existence of leucocytoclastic vasculitis in a skin biopsy specimen, and the presence of nephrotic syndrome with, in the renal biopsy, membranoproliferative glomerulonephritis with parietal and mesangial deposits of IgM and IgG antibodies. The patient is treated by association of pegylated interferon and ribavirin. Evolution was marked by the disappearance of skin lesions and nephrotic syndrome. Conclusion: Association of chronic hepatitis C with mixed cryoglobulinaemia is rarely symptomatic. The appearance of clinical manifestations of cryoglobulinaemia represents an indication to antiviral treatment. doi:10.1016/j.ajg.2009.07.141
(118) Sarcoidosis-associated hepatitis C virus infection: Two cases H. Massit, N. Benzoubeir, H. Tlemsani, I. Errabih, H. Krami, L. Ouazzani, H. Ouazzani Hepatogastroenterology Unit ‘‘B, Universitary Hospital Ibn Sina, Rabat, Morocco
Background: Sarcoidosis is a multisystem granulomatous disorder of unclear etiology. Interferons (IFN) have been implicated in its pathogenesis. Most reported cases of chronic hepatitis C (HCV) associated-sarcoidosis are not the consequence of HCV infection per se, but are the results of interferon antiviral therapy. However, cases of HCV associated-sarcoidosis without interferon therapy have also been recently reported and the possibility of HCV infection per se inducing sarcoidosis by activating host immune systems has been suggested. We report two new cases of association chronic hepatitis C and sarcoidosis. Case reports: Case 1: A 54 years old woman, treated by pegylated interferon alpha and ribavirin for chronic hepatitis C (genotype 1b), She developed cutaneous and pulmonary sarcoı¨dosis about 6 months after beginning treatment. Physical examination revealed the presence of skin lesions on the legs, fore arm, and the face. A skin biopsy revealed sarcoidal type non-necrotizing granulomas in the subcutaneous tissue. Chest radiography and CT-scan showed deep lymphadenopathy. The evolution was favourable after stopping treatment. Case 2: A 50 year old woman with five years history of systemic sarcoidosis involving lung, and spleen treated with prednisolone. She was admitted for elevation of aminotransferase activity and found a chronic hepatitis C (genotype 2). Percutaneous liver biopsy found: Metavir score A1F2 and granulomas are identified, the hepatic histologic findings are compatible with those of hepatic sarcoidosis. The patient was treated by pegylated interferon alpha and
AB51
ribavirin during 6 months without virological response and she developed ocular complication. The antiviral therapy was stopped. Conclusion: There is a potential causal relationship between IFN therapy and sarcoidosis but cases of sarcoidosis and chronic hepatitis C with no history of interferon therapy are reported. Sarcoidosis must also be considered, not only during interferon therapy but also before antiviral therapy, since sarcoidosis may preclude interferon administration. doi:10.1016/j.ajg.2009.07.142
(119) Association of hepatitis C virus infection and immune thrombocytopenic purpura (a new case) F. Laayouni, N. Lakhrib, A. Karim, R. Alaoui, W. Hliwa, W. Badre, A. Bellabah, S. Nadir, A. Cherkaoui Gastro-enterology Department, Chu Ibn Rochd, Casablanca, Morocco
Introduction: Extrahepatic manifestations of viral hepatitis C (HCV) infection are multiples and frequently observed. Immune thrombocytopenic purpura (ITP) represents 10–41% of these manifestations. This association is a real therapeutic challenge. Objectives: The aim of this work is to report a new case of the association HCV infection and ITP and to highlight the therapeutic difficulties. Case report: A 51-year-old woman, with HCV infection (Metavir stage A3F4, was treated by a bitherapy PEG-INF-alpha plus Ribavirin. A severe thrombocytopenia (46.000/ml) revealed by hemorrhagic syndrome was appeared then, antiviral treatment was stopped. Biological examinations revealed an immune thrombocytopenia with positive anti-platelet antibody, thus, the diagnosis of immune thrombocytopenic purpura was considered. There was no amelioration under corticosteroids treatment, imposing its stop. The reintroduction of PEG-INF-alpha and Ribavirin has worsened thrombocytopenia. Interferon therapy was stopped, and two months later, the platelet count was normal under Ribavirin alone. Serum RNA-HCV was negative after 7 months. Conclusion: The HCV infection and ITP association is a result of the fibrotic action of the disease, it is a real therapeutic challenge which require a multidisciplinary approach involving hematologist and hematologist. doi:10.1016/j.ajg.2009.07.143
(120) Acute delirious puff during a treatment by interferon of the chronic hepatitis C (1 case) H. Sammoud, M. Tahiri, H. Elazrak, W. Badre, A. Bellabah, R. Alaoui, A. Cherkaoui Service De Gastroenterologie, CHU Ibn Rochd Casablanca, Morocco
The interferon alpha is a molecule which revolutionized the preview of the hepatitis C. However, neuropsychiatric demonstrations were observed at more than 20% of the patients treated by this molecule. The classically unwanted effect observed is the depression; however, more austere psychoses can arise. We report the observation of an old patient of 54 years without psychiatric antecedent, followed for chronic hepatitis C, genotype 1, F2 on the score of METAVIR and having begun a treatment by interferon Peg alpha 2a and ribavirine. three months after the beginning of the treatment, the patient presented the fast installation of hallucinations in type of perception of animals and strange voices,