1/12. porphyria cutanea tarda and hiv: two cases associated with hepatitis c.hepatitis c virus (HCV) is a probable etiologic factor for the development of porphyria cutanea tarda (PCT), a photosensitive skin disease causing blistering, skin fragility, milia, and scarring. In a review of the literature, the hepatitis c status of patients coinfected with hiv and PCT was not known. Two patients with PCT who were seropositive for hiv and HCV are discussed herein. The appropriateness of performing porphyrin studies in patients diagnosed with hiv and photosensitivity and of prompting physicians to test for hiv and HCV infection in individuals who are diagnosed with PCT is discussed. Because hiv has been isolated from cutaneous blister fluid in patients with PCT and hiv, caregivers should be aware of the infection risk associated with the vesicles and erosions in these patients.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/12. A physician with a positive hepatitis c virus rna test after a needlestick injury.Needlestick accidents continue to be a hazard for healthcare workers. We report the development of acute hepatitis c infection in a physician after needlestick injury. hepatitis c virus (HCV)-rna, seroconversion and a raised plasma alanine aminotransferase (ALAT) level were found in plasma three months after the accident. Treatment with interferon alfa and ribavirin was started. While the physician was on treatment, HCV-rna test results from plasma taken the day treatment was started became available. HCV-rna was undetectable by quantitative bDNA assay, undetectable by qualitative polymerase chain reaction (PCR) and undetectable by transcription mediated amplification (TMA). A dilemma arose at this point: should the patient stop the treatment or continue the planned therapy? The physician decided to continue a 24-week course of treatment. Six months after the end of treatment, the physician was still HCV-rna-negative and with a normal plasma ALAT level. The rationale of the decision to continue therapy is discussed. This information may be useful for clinicians confronted with a similar dilemma.- - - - - - - - - - ranking = 8keywords = physician (Clic here for more details about this article) |
3/12. porphyria cutanea tarda, hepatitis c, alcoholism, and hemochromatosis: a case report and review of the literature.porphyria cutanea tarda (PCT) is associated with estrogen, certain medications, alcohol abuse, hepatitis viruses, and iron overload. Numerous studies have demonstrated an increased incidence of hepatitis c in patients with PCT; therefore, hepatitis screening should be routinely performed on these patients. On the other hand, although studies have long suspected hereditary hemochromatosis (HH) to be an underlying condition of PCT, many physicians have a low index of suspicion. Also, diagnosis of HH has been difficult until recently, when the gene mutation was identified. We present a case of a patient with PCT, hepatitis c, and alcoholism who was homozygous for the HH gene mutation.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/12. hepatitis c virus associated arthritis in absence of clinical, biochemical and histological evidence of liver disease--responding to interferon therapy.BACKGROUND: Extrahepatic manifestations associated with hepatitis c virus (HCV) such as arthritis, vasculitis, cryoglobulinemia, are well known. However, HCV related arthritis in the absence of clinical, biochemical and histological evidence of liver disease is not common. This article deals with such a case and its response to interferon therapy. CASE REPORT: We present a case of a 32 year old Filipino male who presented with bilateral symmetrical painful swelling of multiple joints including, hands, elbows, shoulders, and knees. serum rheumatoid factor, antinuclear antibodies and a comprehensive work-up for rheumatologic disorders were all negative. Both initially and subsequently, serological tests for hepatitis a, B, and autoimmune liver diseases, Wilson's disease, hemochromatosis, syphilis, human immunodeficiency virus (hiv) and cryoglobulinemia were negative, initially and subsequently. However, the hepatitis c antibody test was positive and hepatitis c viral rna was detected in high titers. The joint symptoms did not improve despite therapy with nonsteroidal anti-inflammatory drugs and a short course of prednisone prescribed earlier by his primary care physician. The patient then requested and was subsequently treated with interferon alpha 2b. RESULTS: The patient responded rapidly to the interferon therapy with significant and sustained improvement in joint symptoms and disappearance of hepatitis c viral rna from his serum. CONCLUSIONS: HCV arthritis should be considered in the differential diagnosis of seronegative arthritis of undetermined etiology even in the setting of normal liver chemistries.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/12. Anticoagulant-induced pseudothrombocytopenia occurring after transcatheter arterial embolization for hepatocellular carcinoma.Pseudothrombocytopenia (PTCP) is the in vitro phenomenon of anticoagulant-activated platelet agglutination that results in spuriously low platelet counts. We report the case of a 65-year-old man with EDTA- and sodium citrate-dependent PTCP occurring after transcatheter arterial embolization (TAE) for hepatocellular carcinoma (HCC) due to hepatitis c cirrhosis. Invasion of the portal and hepatic veins by HCC formed severe trans-tumoral arterio-venous shunts that were effectively treated by TAE. Two days after the therapy, PTCP was seen on blood count and continued for 4 months. The patient received unnecessary treatment for disseminated intravascular coagulation (DIC) until the diagnosis of PTCP was established. PTCP is a rare complication but should be considered after TAE for HCC; lack of recognition may lead the physician to misdiagnosis and patient mismanagement.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/12. Non-A, non-B hepatitis and chronic dialysis--another dilemma.To define the incidence of non-A, non-B (NANB) hepatitis and evaluate possible risk factors, we reviewed records of 163 patients on chronic dialysis during a 3-year period. 23 cases of NANB hepatitis occurred, 13 (27%) in 49 center dialysis, 8 (10%) in 77 home hemodialysis (p less than 0.02) and 2 (5%) in 37 peritoneal dialysis patients (p less than 0.01). Hepatitis patients received significantly more transfusions than controls. Numbers of transfusions and of patients transfused were not significantly different in center patients compared to home and peritoneal. 8 NANB patients received no transfusions. NANB was the most common cause of hepatitis in our unit (68%). Although transfusions were a likely etiologic factor, to explain the increased risk in center dialysis patients, disease in patients not transfused and development of NANB hepatitis without a known parenteral exposure in a physician assigned to the nephrology Service, we feel another etiologic factor was important, the dialysis center.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/12. Exacerbation of primary biliary cirrhosis during interferon-alpha 2b therapy for chronic active hepatitis c.A 60-year-old woman with chronic active hepatitis c was treated with 6 million units of rIFN-alpha 2b daily for two weeks and subsequently three times weekly for several months. Histological examination proved a severe form of chronic active hepatitis c unexpectedly complicated with primary biliary cirrhosis (PBC). Before treatment, levels of serum alkaline phosphatase (ALP) or gammaglutamyltranspeptidase (GGT) had remained within normal limits over six months, although anti-mitochondrial antibody (AMA) was shown to be positive. After eight weeks of therapy, the daily dose of rIFN was reduced to 3 million units because of a marked increase of ALP and GGT, although the serum alanine aminotransferase (ALT) was normalized. Four months later, IFN treatment was suspended because of continuous elevation of the ALP and GGT levels, and administration of ursodeoxycholic acid was substituted. Two months later, the ALP and GGT levels returned to the normal range, although ALT was not normalized and HCV-rna remained positive. This is the first report case that demonstrates IFN treatment potentially exacerbates PBC associated with chronic active hepatitis c. It is important for treating physicians to keep this association in mind.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/12. Exacerbation of lichen planus during interferon alfa-2a therapy for chronic active hepatitis c.A 66-year-old man was treated for chronic active hepatitis c with 3 MU of recombinant interferon alfa-2a three times weekly. Nine months before interferon therapy, a mild lichen planus had been diagnosed, which exacerbated within 4 weeks of treatment to a generalized erosive lichen planus. After 8 weeks, interferon therapy was stopped because local measures did not improve skin lesions. Otherwise, the patient tolerated interferon therapy well, and the initially 20-fold elevated aminotransferase levels returned to normal. Four weeks after discontinuation of interferon therapy, nearly all mucosal and skin lesions had disappeared. But 8 weeks after the discontinuation, aminotransferase levels again rose to 10 times the normal range. Treating physicians should know that a preexisting lichen planus will potentially exacerbate as a side effect of interferon alfa-2a therapy of a chronic hepatitis. However, because this is the first report on this association, further observations are needed to decide the clinical relevance.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/12. lichen planus and chronic hepatitis c: exacerbation of the lichen under interferon-alpha-2a therapy.A 51-year-old man was treated for histologically proven chronic hepatitis c with 3 MU of recombinant interferon-alpha-2a three times a week. Before interferon therapy, a mild lichen planus (hypertrophic variant) had been diagnosed, which exacerbated within 6 weeks of treatment to a severe erosive oral form. Then interferon therapy was stopped because local measures did not improve oral lesions. However, the patient tolerated interferon therapy well, and the initially four-fold elevated aminotransferase levels returned to normal. Nine weeks after discontinuation of interferon therapy, nearly all the buccal mucous membrane lesions had disappeared. But 8 weeks after withdrawal of interferon, aminotransferase levels rose again to six times the normal range. Treating physicians should know that a pre-existing lichen planus would potentially exacerbate, as a side effect of interferon-alpha-2a therapy of chronic hepatitis. However, further observations are needed to decide its clinical relevance.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/12. Interferon alfa-associated retinopathy.Interferon alfa and its related compounds have been used for more than 10 years in the treatment of a number of conditions including viral illnesses, childhood hemangiomas, various cancers, and leukemia. The potential applications for this class of medication continue to grow. The use of interferon alfa in experimental protocols has also increased, thus making it more likely that new indications will be discovered. It is probable that primary care physicians will be called on to initiate therapy or will see patients being treated with interferon in their practice. We report the development of interferon-related retinopathy in a 43-year-old man while he was receiving experimental treatment with interferon alfa for hepatitis b virus and hepatitis c virus infection. The vision loss was acute and only partially reversible. Interferon, its mechanism of action, and the past literature are briefly discussed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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