Volume 67 - 2004 - Fasc.4 - Case reports
Hepatitis caused by occupational chronic exposure to trichloroethylene
Trichloroethylene (TCE) is an organic solvent used in a variety of industries for more than 60 years. Several adverse events fol- lowing acute or chronic exposure to trichloroethylene have been reported. However, TCE-induced hepatitis is very rare. We present the case of a 55-year old male who was presented with anorexia, fatigue and upper abdominal discomfort. Routine labo- ratory examination revealed marked elevation of liver enzyme val- ues. All possible causes of hepatitis were ruled out. The patient has been working as a shoemaker, in a small room of a basement, with insufficient air-exchange ; during the last 5 years he used daily a glue containing 1,1,1 trichloroethylene. The diagnosis of hepatitis was confirmed by liver biopsy. The offending agent was with- drawn. Three months later, he was "feeling well" and liver enzyme values had returned to normal. Six months after the initial biopsy, a second liver biopsy was performed and histology was markedly improved. Workers exposed to hazardous chemicals, such as trichloroethylene, must have periodic follow-up examinations. Good work practices are very important when using toxic sub- stances. In patients whose initial diagnostic workout is negative for common causes of acute or chronic hepatitis, toxic causes should be considered, with emphasis on patient's job and working condi- tions. (Acta gastroenterol. belg., 2004, 67, 355-357).
Spontaneous rupture of omental varices : an uncommon cause of hypovolemic shock in cirrhosis
In cirrhotic patients, esophageal and esophagogastric varices are the most common sites of bleeding, often responsible for hypov- olemic shock. Hepatocellular carcinoma, blunt abdominal trauma and postprocedural complications are classical causes of hemo- peritoneum in hepatic cirrhosis. Rupture of omental varices is another and rarely reported cause of shock in cirrhosis. We report a case of hypovolemic shock caused by ruptured omental varices. Selective review of literature regarding presentation, diagnosis and management of ruptured intraabdominal varices is also part of presentation. (Acta gastroenterol. belg., 2004, 67, 351-354)
Nodular regenerative hyperplasia of the liver and Hodgkin's disease : a case report
Nodular regenerative hyperplasia (NRH) of the liver is a rare entity characterized by the presence of nodules in the hepatic parenchyma, not surrounded by fibrous septa. The pathogenesis and etiology are unknown but an association with different dis- eases including some hematological disorders has been described. Its association with Hodgkin's disease is infrequent. We report the case of a 63 years old man who presented symptoms and signs of portal hypertension, hepatocellular failure with progressive dete- rioration and death. Postmortem examination disclosed Hodgkin's disease with hepatosplenic involvement and NRH of the liver. The association of these entities could be explained by the presence of portal infiltration contributing to portal venous obliteration and leading to portal hypertension and formation of the parenchymal nodules characteristic of this entity. Other mechanisms that could cause or influence this association can not be ruled out. (Acta gastroenterol. belg., 2004, 67, 358-360).
Autoimmune pancreatitis with evolution to cholangitis : a case report
We report the case of a 47-year-old Caucasian male patient who presented with obstructive jaundice and mild epigastric pain. Autoimmune pancreatitis was diagnosed based on magnetic reso- nance imaging, biopsy and clinical evolution, and the patient was successfully treated with corticosteroids. However, a few months later ERCP showed an image compatible with sclerosing cholan- gitis. Again, treatment with corticosteroids was given, after which the bile ducts became normal. A few months later, again there was a relapse and azathioprine was started. After decreasing the dose of immunesuppression, we saw relapses of cholangitis and pancre- atitis, with eventually evolution to chronic calcifying pancreatitis.
The aim of this report is to describe autoimmune pancreatitis as a cause of obstructive jaundice, and to illustrate that evolution to an immunesuppression-responsive cholangitis, with evolution to chronic calcifying pancreatitis is possible. AlsO. our patient had a small fluid collection, possibly a pseudocyst, an unusual finding in autoimmune pancreatitis, which disappeared during treatment. (Acta gastroenterol. belg., 2004, 67, 346-350).
Primary lymphoma of liver : A case report and review of literature
Primary lymphoma of liver (PHL) is a rare condition representing less than 1% of extra nodal lymphomas. In contrast, wide spread Hodgkin's lymphoma involves the liver in more than 50% of patients (1-3).
Recently there is an increased frequency of this tumor, especially in the immunocompromised patient (4). PHL is difficult to diagnose and should be considered in the differential diagnosis of solitary or multiple liver lesions especially when alpha-fetoprotein (AFP) and carcino-embrionic antigen (CEA) are normal. Early diagnosis of PHL is important because the prog- nosis appears to be favorable when combination chemotherapy is initiated early (1).
We report a case of primary hepatic lymphoma in an elderly patient, admitted to our department, and review the literature.
