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Virological response after treatment of chronic hepatitis C
e204
Abstracts
The patient was admitted to the hospital, pan-cultured and started on intravenous antibiotics. Physical exam revealed fever, tachycardia, tachypnea, and clear lung fields. Chest X-ray, rapid strep test, blood and urine cultures were negative. Despite treatment with cefepime, vancomycin, levofloxacin and metronidazole, the patient remained febrile with fevers occurring in a cyclic pattern. In addition, the patient developed aphthous ulcers as well as a plaque-like lesion concerning for fungal infection and caspofungin was initiated. Ultimately, the patient developed right upper quadrant pain, and AST and ALT were found to be rising. These peaked at 1701 and 871, respectively. Caspofungin was discontinued and Hepatitis A, B, and C, CMV, EBV, and parvovirus screening were negative. Serum HSV 1 PCR and swab of the oral ulcers for HSV were positive. Antibiotics were discontinued and the patient was started on IV acyclovir. The patient's fever, right upper quadrant pain and transaminases improved over the first 48 h. The patient was discharged on 4 week total acyclovir with complete resolution of her symptoms and normalizing transaminases. Discussion: Liver transaminases elevated to the thousands typically generate a differential diagnosis of acetaminophen toxicity, hepatitis virus infection or ischemic liver disease. Non-hepatitis viruses are less common but must also be considered, especially in an immunocompromised patient, in whom HSV viremia can be rapidly fatal. In this case, correlation of the mouth ulcers and acute hepatitis with the laboratory finding of viremia prompted initiation of acyclovir and reversed the impending liver failure. However, diagnosis was delayed until these physical signs became evident. This case underscores the value of a thorough history and physical in combination with a broad differential in the diagnosis of acute liver failure. In addition, this case highlights the value in testing for other viral causes of liver failure, including HSV, EBV, parvovirus and CMV, in immunocompromised patients.
to walk. On neurological examination, he had slurred speech and poor coordination and unsteady gait. Brain MRI (diffusion weighted image) showed multiple scattered high signal area, which suggested embolism. MR angiography did not reveal any septic aneurysms. We had ordered blood culture, again. On the 14th hospital day Gram positive filamentous rod resembling shape of actynomyces were isolated from two sets of culture bottles. Colonies on blood agar were white and polygonal in shape. We sent specimen for genetic analysis for 16S ribosomal RNA gene to specialized laboratory. We started administration of vancomycin and ceftriaxone and trimethoprim/sulfamethoxazole (STX/TMP) empirically. Trans-thoracic echocardiography could not provide enough quality of images. Only trans-esophageal echocardiography revealed vegetation on anterior mitral valve leaflet. We finally made diagnosis of his disease as infective endocarditis. On the 17th hospital day antibiotics susceptibility revealed its sensitivity to many antibiotics except for vancomycin and STX/TMP. We have switched to monotherapy as penicillin G 1600 mIU/day. His persisting fever ameliorated soon after administration of antibiotics. Results of genetic sequence revealed compatibility with Rothia aeria which was known to be commensal organism of human oral cavity. After receiving 8 week course of penicillin G infusion, and finished rehabilitation program for stroke, he could recover fully and return to home without any after-effects. R. aeria endocarditis is very rare and there is only one case report published before, which reported death due to cerebral hemorrhage as complication. We would like to present our case report as the first case with successful treatment.
doi:10.1016/j.ejim.2013.08.520
ID: 286 Virological response after treatment of chronic hepatitis C D. Stojanovica, Lj. Stalevicb, S. Krsticb
ID: 278 Successful management of Rothia aeria endocarditis with renal transplantation patient: A case report T. Hiraiwa, M. Izumi General Internal Medicine, Saiseikai Utsunomiya Hospital, Utsunomiya City, Japan
A 63 year old man was admitted to our hospital because of persistent fever and generalized malaise lasting for 3 weeks. He had a history of chronic renal failure and renal cell carcinoma. He underwent nephrectomy and cadaveric renal transplantation 5 years before admission. After that, he had to take tacrolimus and everolimus regularly for immunosuppressive therapy, therefore, his grafted kidney had been working well. Three weeks before admission, he suddenly felt chills and his fever went up to 39° without any focal symptoms. He visited his primary care physician office after a week. He was prescribed levofloxacin, but his fever never decreased. Soon, he could not take any foods due to persistent malaise and anorexia. Thus, his condition was getting worse day by day. Thus, he came to our hospital with three week persisting fever. His general appearance was very emaciated and exhausted with fever of 38°. Our physical examination revealed his dental caries with gingival pain and systolic heart murmur. His joints, skin and analysis of urine were normal. Blood chemistry analysis revealed mild leukocytosis. He was admitted to our hospital for medical treatment of fever of unknown origin. On admission, we performed blood and urine culture immediately. We speculated that the cause of his fever was brought by sepsis or viral infection. Thus, we decide waiting the results of both blood and urine culture and viral serology test without using any antibiotics, however, these results revealed negative. On the 10th hospital day, he felt hard
doi:10.1016/j.ejim.2013.08.521
a
Infektivna Klinika, KBC Nis, Nis, Serbia Interna Klinika, KBC Pristina, Pristina, Serbia
b
Viral diagnosis is essential in the detection and monitoring of hepatitis C, but it is much more important in the monitoring of antiviral therapy. The aim of this study was to determine the sustained viral response in patients with hepatitis C and other factors associated with chronic hepatitis C in patients treated with combination therapy with pegylated interferon alpha and ribavirin. We examined 35 patients treated with combined therapy. We determined the serum hepatitis C viral nucleic acid (HCV RNA) before treatment, 12 weeks after the start of treatment and six months after the end of therapy. Sustained viral response defined as HCV RNA nedetektibilna six months after the end of therapy, and virological relapse of HCV RNA as six months after completion of therapy. Demonstrated the effectiveness of combination therapy in the treatment of chronic hepatitis C, and the importance of monitoring the concentration of HCV RNA monitoring therapy success. Monitoring HCV RNA after completion of therapy is important because of the possible occurrence of virological relapse. doi:10.1016/j.ejim.2013.08.522
ID: 291 Hemophagocytic syndrome associated to severe infectious diseases I. Rachdi, I. Boukhris, E. Cherif, S. Azzabi, L. Ben Hassine, I. Kchaou, Z. Kaouech, C. Kooli, N. Khalfallah Internal Medicine, Charles Nicolle Hospital, Tunis, Tunisia
Abstracts
The patient was admitted to the hospital, pan-cultured and started on intravenous antibiotics. Physical exam revealed fever, tachycardia, tachypnea, and clear lung fields. Chest X-ray, rapid strep test, blood and urine cultures were negative. Despite treatment with cefepime, vancomycin, levofloxacin and metronidazole, the patient remained febrile with fevers occurring in a cyclic pattern. In addition, the patient developed aphthous ulcers as well as a plaque-like lesion concerning for fungal infection and caspofungin was initiated. Ultimately, the patient developed right upper quadrant pain, and AST and ALT were found to be rising. These peaked at 1701 and 871, respectively. Caspofungin was discontinued and Hepatitis A, B, and C, CMV, EBV, and parvovirus screening were negative. Serum HSV 1 PCR and swab of the oral ulcers for HSV were positive. Antibiotics were discontinued and the patient was started on IV acyclovir. The patient's fever, right upper quadrant pain and transaminases improved over the first 48 h. The patient was discharged on 4 week total acyclovir with complete resolution of her symptoms and normalizing transaminases. Discussion: Liver transaminases elevated to the thousands typically generate a differential diagnosis of acetaminophen toxicity, hepatitis virus infection or ischemic liver disease. Non-hepatitis viruses are less common but must also be considered, especially in an immunocompromised patient, in whom HSV viremia can be rapidly fatal. In this case, correlation of the mouth ulcers and acute hepatitis with the laboratory finding of viremia prompted initiation of acyclovir and reversed the impending liver failure. However, diagnosis was delayed until these physical signs became evident. This case underscores the value of a thorough history and physical in combination with a broad differential in the diagnosis of acute liver failure. In addition, this case highlights the value in testing for other viral causes of liver failure, including HSV, EBV, parvovirus and CMV, in immunocompromised patients.
to walk. On neurological examination, he had slurred speech and poor coordination and unsteady gait. Brain MRI (diffusion weighted image) showed multiple scattered high signal area, which suggested embolism. MR angiography did not reveal any septic aneurysms. We had ordered blood culture, again. On the 14th hospital day Gram positive filamentous rod resembling shape of actynomyces were isolated from two sets of culture bottles. Colonies on blood agar were white and polygonal in shape. We sent specimen for genetic analysis for 16S ribosomal RNA gene to specialized laboratory. We started administration of vancomycin and ceftriaxone and trimethoprim/sulfamethoxazole (STX/TMP) empirically. Trans-thoracic echocardiography could not provide enough quality of images. Only trans-esophageal echocardiography revealed vegetation on anterior mitral valve leaflet. We finally made diagnosis of his disease as infective endocarditis. On the 17th hospital day antibiotics susceptibility revealed its sensitivity to many antibiotics except for vancomycin and STX/TMP. We have switched to monotherapy as penicillin G 1600 mIU/day. His persisting fever ameliorated soon after administration of antibiotics. Results of genetic sequence revealed compatibility with Rothia aeria which was known to be commensal organism of human oral cavity. After receiving 8 week course of penicillin G infusion, and finished rehabilitation program for stroke, he could recover fully and return to home without any after-effects. R. aeria endocarditis is very rare and there is only one case report published before, which reported death due to cerebral hemorrhage as complication. We would like to present our case report as the first case with successful treatment.
doi:10.1016/j.ejim.2013.08.520
ID: 286 Virological response after treatment of chronic hepatitis C D. Stojanovica, Lj. Stalevicb, S. Krsticb
ID: 278 Successful management of Rothia aeria endocarditis with renal transplantation patient: A case report T. Hiraiwa, M. Izumi General Internal Medicine, Saiseikai Utsunomiya Hospital, Utsunomiya City, Japan
A 63 year old man was admitted to our hospital because of persistent fever and generalized malaise lasting for 3 weeks. He had a history of chronic renal failure and renal cell carcinoma. He underwent nephrectomy and cadaveric renal transplantation 5 years before admission. After that, he had to take tacrolimus and everolimus regularly for immunosuppressive therapy, therefore, his grafted kidney had been working well. Three weeks before admission, he suddenly felt chills and his fever went up to 39° without any focal symptoms. He visited his primary care physician office after a week. He was prescribed levofloxacin, but his fever never decreased. Soon, he could not take any foods due to persistent malaise and anorexia. Thus, his condition was getting worse day by day. Thus, he came to our hospital with three week persisting fever. His general appearance was very emaciated and exhausted with fever of 38°. Our physical examination revealed his dental caries with gingival pain and systolic heart murmur. His joints, skin and analysis of urine were normal. Blood chemistry analysis revealed mild leukocytosis. He was admitted to our hospital for medical treatment of fever of unknown origin. On admission, we performed blood and urine culture immediately. We speculated that the cause of his fever was brought by sepsis or viral infection. Thus, we decide waiting the results of both blood and urine culture and viral serology test without using any antibiotics, however, these results revealed negative. On the 10th hospital day, he felt hard
doi:10.1016/j.ejim.2013.08.521
a
Infektivna Klinika, KBC Nis, Nis, Serbia Interna Klinika, KBC Pristina, Pristina, Serbia
b
Viral diagnosis is essential in the detection and monitoring of hepatitis C, but it is much more important in the monitoring of antiviral therapy. The aim of this study was to determine the sustained viral response in patients with hepatitis C and other factors associated with chronic hepatitis C in patients treated with combination therapy with pegylated interferon alpha and ribavirin. We examined 35 patients treated with combined therapy. We determined the serum hepatitis C viral nucleic acid (HCV RNA) before treatment, 12 weeks after the start of treatment and six months after the end of therapy. Sustained viral response defined as HCV RNA nedetektibilna six months after the end of therapy, and virological relapse of HCV RNA as six months after completion of therapy. Demonstrated the effectiveness of combination therapy in the treatment of chronic hepatitis C, and the importance of monitoring the concentration of HCV RNA monitoring therapy success. Monitoring HCV RNA after completion of therapy is important because of the possible occurrence of virological relapse. doi:10.1016/j.ejim.2013.08.522
ID: 291 Hemophagocytic syndrome associated to severe infectious diseases I. Rachdi, I. Boukhris, E. Cherif, S. Azzabi, L. Ben Hassine, I. Kchaou, Z. Kaouech, C. Kooli, N. Khalfallah Internal Medicine, Charles Nicolle Hospital, Tunis, Tunisia