Journal of Yeungnam Medical Science

Case report

Anti-nuclear antibody-negative immunoglobulin G4-associated autoimmune hepatitis mimicking lymphoproliferative disorders: Min Kyu Kang, Jung Gil Park, Joon Hyuk Choi; Yeungnam Univ J Med. 2020;37(2):136-140. Published online March 24, 2020; DOI: https://doi.org/10.12701/yujm.2020.00066

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Immunoglobulin G4 (IgG4)-associated autoimmune hepatitis (AIH) is a very rare subtype of autoimmune hepatitis and characterized by marked elevated serum IgG and hepatic infiltration of IgG4-expressing plasma cells. Pathologic confirmation of hepatic IgG4-expressing plasma cells is usually required for the final diagnosis of IgG4-associated AIH. Herein, we report the case of a 47-year-old female diagnosed with autoantibody-negative IgG4-associated AIH mimicking lymphoproliferative disorders.

Citations

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Hepatic Involvement of Diffuse Large B-Cell Lymphoma Mimicking Antinuclear Antibody-Negative Autoimmune Hepatitis Diagnosed by Liver Biopsy
Euna Lee, Min-Kyu Kang, Gabin Moon, Mi-Jin Gu
Medicina.2022; 59(1): 77. CrossRef
Immunoglobulin G4 (IgG4)‐related autoimmune hepatitis and IgG4‐hepatopathy: A histopathological and clinical perspective
Atsushi Tanaka, Kenji Notohara
Hepatology Research.2021; 51(8): 850. CrossRef

Review article

Pharmacologic therapy for nonalcoholic steatohepatitis focusing on pathophysiology: In Cheol Yoon, Jong Ryeol Eun; Yeungnam Univ J Med. 2019;36(2):67-77. Published online April 11, 2019; DOI: https://doi.org/10.12701/yujm.2019.00171

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Abstract PDF

The paradigm of chronic liver diseases has been shifting. Although hepatitis B and C viral infections are still the main causes of liver cirrhosis and hepatocellular carcinoma (HCC), the introduction of effective antiviral drugs may control or cure them in the near future. In contrast, the burden of nonalcoholic fatty liver disease (NAFLD) has been increasing for decades, and 25 to 30% of the general population in Korea is estimated to have NAFLD. Over 10% of NAFLD patients may have nonalcoholic steatohepatitis (NASH), a severe form of NAFLD. NASH can progress to cirrhosis and HCC. NASH is currently the second leading cause to be placed on the liver transplantation list in the United States. NAFLD is associated with obesity, type 2 diabetes, dyslipidemia, and metabolic syndrome. The pathophysiology is complex and associated with lipotoxicity, inflammatory cytokines, apoptosis, and insulin resistance. The only proven effective treatment is weight reduction by diet and exercise. However, this may not be effective for advanced fibrosis or cirrhosis. Therefore, effective drugs are urgently needed for treating these conditions. Unfortunately, no drugs have been approved for the treatment of NASH. Many pharmaceutical companies are trying to develop new drugs for the treatment of NASH. Some of them are in phase 2 or 3 clinical trials. Here, pharmacologic therapies in clinical trials, as well as the basic principles of drug therapy, will be reviewed, focusing on pathophysiology.

Citations

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Unlocking the Therapeutic Potential of Ellagic Acid for Non-Alcoholic Fatty Liver Disease and Non-Alcoholic Steatohepatitis
Tharani Senavirathna, Armaghan Shafaei, Ricky Lareu, Lois Balmer
Antioxidants.2024; 13(4): 485. CrossRef
Mechanism of PANoptosis in metabolic dysfunction-associated steatotic liver disease
Keying Ni, Lina Meng
Clinics and Research in Hepatology and Gastroenterology.2024; 48(7): 102381. CrossRef
Effect of Lactobacillus rhamnosus hsryfm 1301 Fermented Milk on Lipid Metabolism Disorders in High-Fat-Diet Rats
Hengxian Qu, Lina Zong, Jian Sang, Yunchao Wa, Dawei Chen, Yujun Huang, Xia Chen, Ruixia Gu
Nutrients.2022; 14(22): 4850. CrossRef
Oxidative Stress Is a Key Modulator in the Development of Nonalcoholic Fatty Liver Disease
Yuanqiang Ma, Gyurim Lee, Su-Young Heo, Yoon-Seok Roh
Antioxidants.2021; 11(1): 91. CrossRef
Elevated 1-h post-load plasma glucose levels in normal glucose tolerance children with obesity is associated with early carotid atherosclerosis
Suna Kılınç, Tuna Demirbaş, Enver Atay, Ömer Ceran, Zeynep Atay
Obesity Research & Clinical Practice.2020; 14(2): 136. CrossRef
Pathophysiology of NAFLD and NASH in Experimental Models: The Role of Food Intake Regulating Peptides
L. Kořínková, V. Pražienková, L. Černá, A. Karnošová, B. Železná, J. Kuneš, Lenka Maletínská
Frontiers in Endocrinology.2020;[Epub] CrossRef

Case Report

Chronic hepatitis C healed by peginterferon-α and rivabirin treatment after kidney transplantation.: Min Gue Seok, Tae Hee Lee, Sung Ro Yun, Won Min Hwang, Se Hee Yoon, In Soo Choe, Seong Joo Kang, Ju Young Hong, Dae Sung Kim; Yeungnam Univ J Med. 2016;33(2):150-154. Published online December 31, 2016; DOI: https://doi.org/10.12701/yujm.2016.33.2.150

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Abstract PDF: Hepatitis C virus (HCV) infection is present in a high proportion of patients with kidney transplantation. Compared with uninfected kidney transplant recipients, HCV infected kidney recipient have higher prevalence of liver disease and worse allograft survival after transplantation. Interferon monotherapy before transplantation is standard therapy for HCV-infected kidney transplant candidates. If HCV infection is discovered after transplantation, interferon monotherapy is considered due to the limited critical situation. However, in this patient, who was a kidney recipient, HCV infection was treated after kidney transplantation with peginterferon-α and rivabirin. As a result, the patient achieved sustained virologic response.

Review

Obesity and Insulin Resistance in Childhood.: Kwang Hae Choi; Yeungnam Univ J Med. 2012;29(2):73-76. Published online December 31, 2012; DOI: https://doi.org/10.12701/yujm.2012.29.2.73

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Abstract PDF: More and more children are becoming obese and overweight due to several factors that include a high energy density in the diet (a high fat intake) and low energy expenditure. Consequently childhood obesity is becoming a significant health problem. Fat tissue releases many cytokines such as resistin, tumor necrosis factor-alpha, leptin, interleukin-6. These adipocytokines induce obesity-related insulin resistance. Insulin resistance is a key component of obesity-related metabolic problems such as hypertension, type 2 diabetes mellitus, dyslipidemia, non-alcoholic steatohepatitis, acanthosis nigricans and polycystic ovarian syndrome. This review article focused on insulin resistance and its related metabolic diseases.

Case Reports

A Case of Small Bowel Intussusception Caused by Jejunal Hamartoma Confused as Hepatitis A in an Adult.: Joon Hur, Gu Min Cho, Young Ook Eum, Ji Young Park, Mi Sung Kim, Byung Seong Ko, Hyang Mi Shin, Seung Myoung Son; Yeungnam Univ J Med. 2012;29(2):110-112. Published online December 31, 2012; DOI: https://doi.org/10.12701/yujm.2012.29.2.110

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Abstract PDF: Intussusception in adult is a rare disease and laparotomy is usually considered because of the probability of malignancy. Especially with obstruction symptom or sign, it might be needed emergency operation. This case was a simultaneous development of small bowel intussusception and acute hepatitis A. The patient had abdominal pain and vomiting. Intitial laboratory examination with elevated aminotransferase revealed that the diagnosis was acute hepatitis. As managing acute hepatitis, the abdominal pain was not improved and the patient had tenderness on periumbilical area on physical examination. A jejunal intussusception with a lead point was proved on the abdominal computed tomography scan. Fortunately, symptom of intussusception was relieved while nulli per os (NPO) and intravenous hydration. After recovery of acute hepatitis, laparotomy was done. The lead point was 2.5x3.0 cm sized hamartoma. This was the case that the symptom of intussusception was confused with that of acute hepatitis.

Rhabdomyolysis and Mild Kidney Injury in a Patient with Acute Hepatitis A.: Gu Min Cho, Chang Wook Kim, Hyeonjin Seong, Joon Hur, Bu Seok Jeon, Jonghwan Lee, Eun Hui Sim, Seok Jong Lee, Chang Don Lee; Yeungnam Univ J Med. 2012;29(1):28-30. Published online June 30, 2012; DOI: https://doi.org/10.12701/yujm.2012.29.1.28

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Abstract PDF: A 48-year-old male visited the emergency room of the authors' hospital due to nausea, vomiting, and myalgia for four days. Acute hepatitis A was identified from the serologic marker of the hepatitis A virus. Mild elevation of the serum creatinine and creatinine phosphokinase (CPK) suggested rhabomyolysis, which was confirmed with the serum aldolase, myoglobin, and urine myoglobin. With supportive care, both the liver and renal functions were recovered gradually and fully. This case shows that rhabdomyolysis can be one of the mechanisms of renal complication in cases of acute symptomatic hepatitis A.

A Case of Acute Renal Failure Associated with Non-fulminant Acute Hepatitis A.: Ji Hoon Na, Jong Won Park, Kyu Hwan Park, Myong Jin Oh, Yun Jung Choi, Jung Min Park, Woo Jin Chang; Yeungnam Univ J Med. 2010;27(2):127-132. Published online December 31, 2010; DOI: https://doi.org/10.12701/yujm.2010.27.2.127

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Abstract PDF: Acute hepatitis A is a generally self-limiting disease of the liver. Acute renal failure is rare in patients with acute non-fulminant hepatitis A. Acute tubular necrosis is the most common form of renal injury found in such patients. The 36 years old male patient visited our hospital with complaint of general weakness, fatigue, nausea, vomiting and myalgia. He was diagnosed with acute renal failure associated with acute non-fulminant hepatitis A. We report here on a case of acute renal failure associated with non-fulminant hepatitis A, and we include a review of the literature.

Original Articles

The Short Term Efficacy of Entecavir Therapy in Chronic Hepatitis B.: Hyun Kim, Hee Bok Chae, Won Joong Jeon, Seon Mee Park, Sei Jin Youn, Jong Ryul Eun, Heon Ju Lee; Yeungnam Univ J Med. 2008;25(1):31-40. Published online June 30, 2008; DOI: https://doi.org/10.12701/yujm.2008.25.1.31

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Abstract PDF: BACKGROUND
/AIMS: Entecavir is a synthetic nucleoside analogue, cyclopentyl guanine nucleoside, which has a potent antiviral effect and the least viral breakthrough in hepatitis B virus (HBV) replication. Entecavir has been available in Korea since 2007 but there are few reports on its effects. The aim of this study was to evaluate the virological response (VR) and biochemical response (BR) to entecavir in HBV patients at 3, 6 and 9 months after treatment with entecavir. MATERIALS AND METHODS: Thirty-three chronic hepatitis B patients who took entecavir for at least 9 months were enrolled. We investigated VR and BR by retrospectively reviewing medical records. Patients who satisfied the following criteria were chosen: 1) initial alanine aminotransferase (ALT) levels = 1.5upper limit of normal (ULN) and 2) initial HBV DNA levels = 5 log10 copies/ml. We measured ALT levels every 3 months until month 9. HBV DNA was measured every 2 or 3 months by polymerase chain reaction (PCR) method. RESULTS: Most patients taking entecavir showed good BR (ALT < 40 IU/L). The BR rates were 61%, 73% and 67% at months 3, 6 and 9, respectively. VR (HBV DNA < 5 log(10) copies/ml or 2 log lower than initial HBV DNA) rates were 82%, 91% and 91% at months 3, 6 and 9, respectively. Undetectable HBV DNA (HBV DNA < 4 log(10) copies/ml) rates were 49%, 73% and 85% at months 3, 6 and 9, respectively. Two patients presented with virological breakthrough without adverse effects until month 9. CONCLUSIONS: Entecavir showed good BR and VR from month 3 and these effects continued through the 9-month observation period. This suggests that entecavir is also a good choice for the first line treatment of chronic hepatitis B (CHB). Further studies are needed to determine the long-term efficacy and drug resistance of entecavir in Korean CHB patients.

Clinical Characteristics of Adult Patients with Acute Hepatitis A.: Jong Ryul Eun, Heon Ju Lee, Tae Nyeun Kim, Byung Ik Jang, Hee Jung Moon; Yeungnam Univ J Med. 2007;24(2):170-178. Published online December 31, 2007; DOI: https://doi.org/10.12701/yujm.2007.24.2.170

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Abstract PDF

BACKGROUND
The incidence of acute hepatitis A in adults has recently been increasing. This study was conducted to investigate the epidemiology and clinical characteristics of acute hepatitis A in Daegu province over the past 10 years. MATERIALS AND METHODS: We reviewed the medical records of 55 patients (male/female: 34/21), who were diagnosed with acute hepatitis A by confirmation of the IgM anti-HAV between January 1998 and June 2007. RESULTS: The mean age was 29.7+/-10.3 years (range; 17-65 years). The incidence was most common between March and June (56.1%), in the third and fourth decades of life (78.2%) and 90.9% (50/55) of the patients were diagnosed from 2003 to present. The common symptoms included anorexia, nausea or vomiting (69.1%), fever and chills (49.1%), myalgia (47.3%), weight loss (47.3%), fatigue (40.0%), abdominal pain (36.4%), diarrhea (9.1%) and pruritus (5.5%). The mean duration of hospital stay was 8.6+/-3.4 days (range; 3-20 days). The route of transmission was identified in only 11 patients (20.0%); 7 patients (12.7%) traveled (abroad or domestic), 2 patients (3.6%) ingested raw food and 2 patients (3.6%) had friends with acute hepatitis A. Fifty four patients recovered without complication; one patient developed fulminant hepatitis and recovered after a liver transplantation. CONCLUSION: The incidence of acute hepatitis A in adults is increasing. Because of the cost of treatment and potential for serious disease, persons, under 40 are recommened to have hepatitis A vaccination and confirmation of IgG anti-HAV.

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Pattern of Hepatitis A Incidence According to Area Characteristics Using National Health Insurance Data
Joo Youn Seo, Jae Hee Seo, Myoung Hee Kim, Moran Ki, Hee Suk Park, Bo Youl Choi
Journal of Preventive Medicine & Public Health.2012; 45(3): 164. CrossRef

Clinical Features of Cholestatic Hepatitis.: Sun Taek Choi, Jong Ryul Eun, Song Woo Lim, Bong Jun Kim, Heoon Ju Lee, Mi Jin Gu, Joon Hyuk Choi; Yeungnam Univ J Med. 2001;18(1):51-58. Published online June 30, 2001; DOI: https://doi.org/10.12701/yujm.2001.18.1.51

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Abstract PDF: BACKGROUND
Cholestatic hepatitis is failure of bile to reach the duodenum with hepatocellular damage and no demonstable obstruction of the major bile ducts. The prognosis of usually good with recovery in less than 4 weeks after withdrawal of the offending drug. However, a prolonged causes of Chronic liver disease is needed. MATERIALS AND METHODS: From January 1991 through January 2000, 14 patients diagnosed as cholestatic hepatitis by liver biopsy were included. The possible causative drug, clinical features, laboatory findings, and progression of cholestatic hepatitis were evaluated. The semiquantitative study of liver lesions was performed by two independent observers. RESULTS: Causes of cholestatic hepatitis are 5 cases of oriental medicine, 3 cases of anti-tuberculosis medication, 1 case of ticlopidine and antibiotics and 4 cases of unknown causes. The clinical features of cholestatic hepatitis were jaundice, itching, urine color change, and general weakness. During 6 to 50 months, LFT of 5 patients showed prolonged elevation. Elevated total cholesterol > or =250 mg/dL in 6 patients, pheripheral blood eosinophilia in 5 patients, auto-antibody positive in 6 patients were observed respectively. The biopsies showed intralobular bilirubinostasis with a mixed portal inflammatory infiltration. CONCLUSION: In chlestatic hepatitis, durations of abnormal LET are variable regardless of causative drugs. If chlestatic hepatitis progresses toward chronic course, viral hepatitis, primary biliary cirrhosis, and autoimmune hepatitis should be differentially diagnosed and sequential liver biopsies are needed.

Effect of alpha-Interferon 2b on Chronic Hepatitis B Patients with High Serum ALT.: Heon Ju Lee, Young Doo Song; Yeungnam Univ J Med. 1998;15(2):237-245. Published online December 31, 1998; DOI: https://doi.org/10.12701/yujm.1998.15.2.237

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Abstract PDF: No abstract available.

Comparison of Three Third-generation Anti-HCV Enzyme Immunoassay Tests.: Hee Soon Cho, Jin Young Moon, Chae Hoon Lee, Kyung Dong Kim; Yeungnam Univ J Med. 1998;15(1):143-150. Published online June 30, 1998; DOI: https://doi.org/10.12701/yujm.1998.15.1.143

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Abstract PDF: The aim of this study was to evaluate domestic enzyme immunoassay(EIA) kit ?LG HCD 3.0?(LG) for the detection of antibody to hepatitis C virus(anti-HCV) in comparision with Axsym HCV version 3.0(Axsym), Cobas Core anti-HCV EIA(Cobas). Cobas kit shows better clear distinction between positive and negative by signal/cutoff ratio(S/C), but it also reveal relatively high false positive rate. The concordance rate of test results between LG and Axsym was 96.2%, between LG and Cobas was 95.5%, and total agreement between three EIA kit was 93.9%. LG were relative poor distinction between positive and negative results, but it could be applied clinically as a screening tool for hepatitis C in general population. The S/C of one false negative result by LG was 0.91, and false positive were less than 4.0, therefore we concluded it is necessary to confirm by immunoblotting assay when S/C were between 0.8 and 4.0.

Prevalence of HBV DNA in Packed Red Blood Cells.: Chae Hoon Lee, Chung Sook Kim, Dal Ho Song; Yeungnam Univ J Med. 1995;12(2):339-346. Published online December 31, 1995; DOI: https://doi.org/10.12701/yujm.1995.12.2.339

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Abstract PDF: Assays for HBsAg, HBV DNA, anti-HBc and anti-HBs of 285 units of packed red blood cells supplied by Taegu Red Cross Blood Center were performed to evaluate the correlation between the prevalence of HBV DNA and the serologic markers for hepatitis B virus. None of 285 plasma samples was positive for HBsAg, however, HBV DNA were detected by polymerase chain reaction in 2 samples which both presented only with anti-HBc positivity.. Of 204 samples tested for anti-HBs, 96 samples(47.1%) were positive and among 216 samples tested for anti-HBc, 80 samples(37.0%) were positive. Of 193 samples tested for both anti-HBs and anti-HBc, 80(41.1%) were all negative and 48(24.9%) were positive on both tests. Those samples which showed positivity only to anti-HBc were 25(13.0%). Considering the above results, transfusion-transmitted hepatitis B virus infection could be prevented by discarding anti-HBc positive blood, however, that may bring insufficient supply of donor bloods in the country like Korea where the prevalence of anti-HBc is high. Anti-HBc positive blood unequivocally positive for anti-HBs should be considered noninfectious for HBV and should be allowed to be transfused. It would reduce the amount of discarding donor blood as the routine blood donor screening tests presently used at Korea Red Cross Blood Center supplemented by anti-HBs and anti-HBc testing.

Effect of alpha-interferon treatment on serum ALT levels in patients with chronic hepatitis C.: Heon Ju Lee; Yeungnam Univ J Med. 1993;10(1):190-196. Published online June 30, 1993; DOI: https://doi.org/10.12701/yujm.1993.10.1.190

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Abstract PDF

The prognosis of chronic hepatitis C is very variable. In some, the disease is progressive and cirrhosis can develop from chronic hepatitis C. Hepatitis C virus (HCV) may act as a trigger towards hepatocellular carcinoma in patients with cirrhosis. Interferon has been used for the treatment of chronic hepatitis C in abroad. 16 patients with chronic C liver disease were treated with alpha-interferon (alfa-2b : "Intron A" Schering Corp. Kenilworth, NJ). All patients were given alpha-interferon in subcutaneous doses of 3 million units three times weekly for 1 to 9 months. During therapy, CBC and ALT levels were checked weakly to monthly. After therapy,. patients were followed for 1 to 8 months. Among 16 patients treated with alpha-interferon, progressive decrease of ALT levels was observed in 14 (87.5%). In 11 patients (68.8%), ALT levels fell into the normal range during therapy, and in 9 of 11, within one month after therapy. 6 months after the completion of therapy in 4 of 9 patients (44.4%) whose ALT levels were in the normal range. alpha-interferon seems to have effect in controlling disease activity in patients with chronic hepatitis C. But the changes in the usage of alpha-interferon, dose and duration, long term follow up and more convenient and simple tests for HCV detection are recommended for the better effect and the exact evaluation on the effect of alpha-interferon therapy in patients with chronic hepatitis C.

Citations

Citations to this article as recorded by

Chronic hepatitis C healed by peginterferon-α and rivabirin treatment after kidney transplantation
Min Gue Seok, Tae Hee Lee, Sung Ro Yun, Won Min Hwang, Se Hee Yoon, In Soo Choe, Seong Joo Kang, Ju Young Hong, Dae Sung Kim
Yeungnam University Journal of Medicine.2016; 33(2): 150. CrossRef

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