Submassive liver necrosis in a hepatitis B carrier with Cushing's syndrome
Journal
Journal of the Formosan Medical Association
Journal Volume
101
Journal Issue
2
Pages
156-158
Date Issued
2002
Author(s)
Abstract
Reactivation of hepatitis B virus (HBV) replication in hepatitis B surface antigen (HBsAg)-positive patients is associated with immunosuppressive therapy. However, the interactions between endogenous glucocorticoid in Cushing's syndrome and HBV-related hepatitis remain unclear. Here, we describe the management of a 32-year-old male HBV carrier with Cushing's syndrome caused by an adrenal cortical adenoma, who developed severe hepatitis B. Repeated episodes of septicemia resulting from hypercotisolemia-related immunosuppression further compromised his hepatic condition. Adrenalectomy could not be performed due to coagulopathy. Lamivudine was not available at that time in Taiwan, and this patient died of hepatic failure and sepsis. At autopsy, his liver showed submassive necrosis with small regenerative nodules. The hepatocytes were positive for HBsAg (membrane and cytoplasmic) and hepatitis B core antigen (nuclear and cytoplasmic). Screening for HBsAg is of crucial significance for immunocompromised individuals. Once positive HBsAg is detected in immunosuppressed patients, liver function and viral status should be closely monitored to enable earlier diagnosis and prompt treatment with the newer nucleoside analogues that actively fight HBV.
SDGs
Other Subjects
hepatitis B antigen; hepatitis B core antigen; immunosuppressive agent; ketoconazole; lamivudine; nucleoside analog; adrenal cortex adenoma; adrenalectomy; adult; antigen detection; article; autopsy; blood clotting disorder; case report; cell membrane; cell nucleus; Cushing syndrome; cytoplasm; death; disease carrier; disease severity; dose response; early diagnosis; hepatitis B; human; human tissue; hypercortisolism; immunosuppressive treatment; liver cell; liver failure; liver function; liver necrosis; liver nodule; liver regeneration; liver toxicity; male; patient monitoring; screening test; septicemia; Taiwan; Adult; Carrier State; Cushing Syndrome; Fatal Outcome; Hepatitis B; Hepatitis B Surface Antigens; Humans; Immunosuppressive Agents; Liver; Male; Necrosis
Type
journal article