| Revista: | Annals of hepatology |
| Base de datos: | PERIÓDICA |
| Número de sistema: | 000419065 |
| ISSN: | 1665-2681 |
| Autors: | Krawczyk, Marcin1 Grunhage, Frank1 Langhirt, Miriam1 Bohle, Rainer M2 Lammert, Frank1 |
| Institucions: | 1Saarland University Medical Center, Department of Medicine II, Homburg. Alemania 2Saarland University Medical Center, Institute of Pathology, Homburg. Alemania |
| Any: | 2012 |
| Període: | Sep-Oct |
| Volum: | 11 |
| Número: | 5 |
| Paginació: | 710-714 |
| País: | México |
| Idioma: | Inglés |
| Tipo de documento: | Artículo |
| Enfoque: | Caso clínico |
| Resumen en inglés | Hepatitis A virus (HAV) infection resolves in most patients uneventfully within weeks from the onset of the disease. In rare cases, however, it may relapse or cause prolonged cholestasis. Here we present a case of a 36-year-old female patient who developed severe pruritus and jaundice three weeks after initially uncomplicated hepatitis A. A relapse of the infection was excluded. Since therapy with colestyramin, antihistaminics, naloxon and ursodeoxycholic acid (UDCA) did not improve symptoms, we decided to perform plasma absorption and to start rifampicin therapy. Under these measures, pruritus and jaundice, as well as serum bilirubin levels improved gradually and after four plasmapheresis sessions we were able to discharge the patient. Genetic testing showed the presence of two procholestatic polymorphisms, the c.3084 [GG] variant within the gene encoding the hepatocanalicular bile salt transporter ABCB11 and the c.711 [AT] variant of the phosphatidylcholine floppase ABCB4. We speculate that this compound ABCB4- ABCB11 genotype led to a severe intrahepatic cholestasis in the setting of HAV infection. In conclusion, our case suggests that polymorphisms within the hepatocanalicular transporters may contribute to a more pronounced course of HAV infection. Although dedicated studies in large cohorts of patients are needed to confirm this observation, we speculate that patients carrying procholestatic hepatobiliary transporter variants may benefit from vaccination against hepatitis A |
| Disciplines | Medicina |
| Paraules clau: | Gastroenterología, Hepatitis aguda, Virus de la hepatitis A, Colestasis, Plasmaféresis |
| Keyword: | Gastroenterology, Acute hepatitis, Hepatitis A virus, Cholestasis, Plasmapheresis |
| Text complet: | Texto completo (Ver PDF) |
