Acute Icteric Hepatitis Research Articles

Yinchen gongying decoction mitigates CCl4-induced chronic liver injury and fibrosis in mice implicated in inhibition of the FoxO1/TGF-β1/ Smad2/3 and YAP signaling pathways

Ethnopharmacological relevanceLiver fibrosis (LF) is a common reversible consequence of chronic liver damage with limited therapeutic options. Yinchen Gongying decoction (YGD) composed of two homologous plants: (Artemisia capillaris Thunb, Taraxacum monochlamydeum Hand.-Mazz.), has a traditionally application as a medicinal diet for acute icteric hepatitis. However, its impact on LF and underlying mechanisms remain unclear. Aim of the studyThis study aims to assess the impact of YGD on a carbon tetrachloride (CCl4) induced liver fibrosis and elucidate its possible mechanisms. The study seeks to establish an experimental foundation for YGD as a candidate drug for hepatic fibrosis. Materials and methodsLC-MS/MS identified 11 blood-entry components in YGD, and network pharmacology predicted their involvement in the FoxO signaling pathway, insulin resistance, and PI3K-AKT signaling pathway. Using a CCl4-induced LF mouse model, YGD's protective effects were evaluated in comparison to a positive control and a normal group. The underlying mechanisms were explored through the assessments of hepatic stellate cells (HSCs) activation, fibrotic signaling, and inflammation. ResultsYGD treatment significantly improved liver function, enhanced liver morphology, and reduced liver collagen deposition in CCl4-induced LF mice. Mechanistically, YGD inhibited HSC activation, elevated MMPs/TIMP1 ratios, suppressed the FoxO1/TGF-β1/Smad2/3 and YAP pathways, and exhibited anti-inflammatory and antioxidant effects. Notably, YGD improved the insulin signaling pathway. ConclusionYGD mitigates LF in mice by modulating fibrotic and inflammatory pathways, enhancing antioxidant responses, and specifically inhibiting FoxO1/TGF-β1/Smad2/3 and YAP signal pathways.

Hepatitis E infection: A review.

Hepatitis E virus (HEV) is a small non-enveloped virus that is transmitted via the fecal-oral route. It is a highly common cause of acute hepatitis, particularly in low to middle income regions of Asia, Africa, and Central America. Most cases are self-limited, and symptomatic patients usually present with acute icteric hepatitis. A subset of patients including pregnant women, older men, those with pre-existing liver disease and immunocompromised patients however, may develop severe disease and hepatic failure. Immunocompromised patients are also at risk for chronic infection, and their immunosuppression should be decreased in order to facilitate viral clearance. HEV can also present with a variety of extra-intestinal manifestations including neurological, renal, hematological, and pancreatic derangements. The gold standard of diagnosis is HEV ribonucleic acid detection via nucleic acid amplification testing. Currently, there are no approved treatments for Hepatitis E, though ribavirin is the most commonly used agent to reduce viral load. Studies assessing the safety and efficacy of other antiviral agents for HEV are currently underway. HEV vaccination has been approved in China, and is currently being investigated in other regions as well. This review article aims to discuss the epidemiology, pathogenesis, presentation, diagnosis, complications, and treatment of Hepatitis E infection.

Acute hepatitis following mRNA BNT162b2 COVID-19 vaccination.

BACKGROUND: Widespread administration of COVID-19 vaccinations have led to reports of rare but potentially serious side effects. METHODS: We present two cases of acute hepatitis following mRNA BNT162b2 (Comirnaty, Pfizer-BioNTech) vaccination. RESULTS: A 25-year-old male presented to hospital with progressive jaundice 5 days following his second dose of Comirnaty. Initial bloodwork revealed severe hepatocellular enzyme elevation and conjugated hyperbilirubinemia with preserved INR. Extensive serologic workup was negative, with normal imaging. Percutaneous liver biopsy was performed and revealed acute cholestatic hepatitis possibly related to drug-induced liver injury. He was started on prednisone 40 mg daily with good initial response but had a second flare; a biopsy was repeated which showed near-identical findings. Steroids were discontinued given non-response and the patient had gradual near complete resolution of liver enzymes and hyperbilirubinemia. A 32-year-old male presented with a 4-week history of nausea followed by progressive choluria, jaundice, and pruritis. He received his second dose of Comirnaty vaccination two weeks prior to presentation. Initial bloodwork showed mixed enzyme elevation with hyperbilirubinemia. Serological workup and imaging were unrevealing. He underwent liver biopsy which showed severe intrahepatic cholestasis, with drug-induced liver injury being suggested as most likely cause. His course was self-limited with resolution of serological abnormalities and symptoms. CONCLUSIONS: While overwhelmingly safe on a population level, our case series illustrate two cases of acute icteric hepatitis following mRNA BNT162b2 vaccination. Clinicians should be aware of this association with hepatic inflammation and consider vaccine history an important component of evaluating patients with acute liver injury.

Incidence of hepatitis A in children with acute icteric hepatitis of district Shopian of Kashmir

Background: Viral hepatitis is a major health problem worldwide. It is caused by at least five hepatotropic viruses, hepatitis A virus being the commonest one. The virus is responsible for most forms of acute benign hepatitis, although fulminant hepatic failure can occur. HAV spreads mainly through the fecal-oral route and hence is preventable by precautionary methods. Hepatitis A vaccine is available and highly effective in preventing disease. Objective of current study was to find the incidence of hepatitis A in children with features of acute icteric hepatitis of district Shopian of Kashmir.Methods: We sampled 83 children aged above 1 year to 17 years who attended the hospital for different features suggestive of hepatitis and evaluated them after proper and detailed history followed by relevant investigations and serology. Cases were labelled positive or negative on the basis of HAV IgM antibody.Results: We had 83 cases, 36 were boys (43.37%) and 47 were girls (56.62%). The girls made just more than a half of the cases and the boys just below half the cases. 13.25% (11 cases) were aged 1 to 4 years (none was below 2 years), 32.53% (27) were 4 to 7years, 32.53% (27) were 7 to 10 years, 16.87% (14) were 10 to 13 years, only 4.82% (4 cases) reported were 13 to 17 years. All 83 proved to be hepatitis A (100%).Conclusions: This study found that the incidence of hepatitis A in children with features of acute icteric hepatitis is very high in the children of district Shopian & a survey with a very large sample size will be ideal.

The ethanolic extract of Artemisia anomala exerts anti-inflammatory effects via inhibition of NLRP3 inflammasome

BackgroundArtemisia anomala S. Moore (Compositae), known as “Nan-Liu-Ji-Nu” in traditional Chinese medicine (TCM), has been used to treat many inflammatory diseases, including enteritis, acute icteric hepatitis, rheumatism, toothache, tonsillitis, and chronic bronchitis, for centuries. Our preliminary studies have demonstrated that the ethanolic extract of A. anomala (EAA) might be with the potential of inhibiting the activation of the NLRP3 inflammasome. However, the anti-inflammatory activity of EAA based on NLRP3 inflammasome inhibition is still unclear. PurposeThis work aimed to elucidate the anti-inflammatory mechanism of EAA by inhibiting NLRP3 inflammasome activation. MethodsLipopolysaccharide (LPS)-primed bone marrow-derived macrophages (BMDMs) were used to evaluate the inhibitory effects on NLRP3 inflammasome activation. The level of IL-1β was determined by ELISA. The expression levels of IL-1β, caspase-1, NLRP3, and ASC were assayed using western blot analysis. ASC oligomerization and speck formation were detected by immunofluorescence microscopy. The measurements of intracellular chloride and potassium were conducted using N-(ethoxycarbonylmethyl)-6-methoxyquinolinium bromide (MQAE) probe assay and inductively coupled plasma-optical emission spectrometry (ICP-OES), respectively. Mitochondrial reactive oxygen species (mtROS) were examined using the MitoSOX method. Acridine orange (AO) staining was used to detect the permeability of the lysosomal membrane. A DSS-induced ulcerative colitis model was established to evaluate the anti-inflammatory effects of EAA in vivo. Finally, high-performance liquid chromatography (HPLC) was employed to identify and quantify the major constituents of EAA. ResultsIn BMDMs, EAA significantly inhibited the release of IL-1β induced by LPS. The mechanistic study revealed that EAA inhibited NLRP3 inflammasome activation by blocking the oligomerization of ASC and suppressed the LPS-induced priming step. Furthermore, EAA protected lysosomes by inhibiting the TAK1-JNK pathway, thereby inhibiting the assembly of downstream NLRP3 inflammasome and the production of IL-1β. In addition, EAA exerted potent protective effects in an ulcerative colitis model by decreasing the content of colonic IL-1β and alleviating the process of ulcerative colitis. HPLC analysis identified eight main components of EAA, including isofraxidin (1), quercetin-7-O-β-D-glucopyranoside (2), apigenin-7-O-β-D-glucopyranoside (3), 7-methoxycoumarin (4), quercetin (5), luteolin (6), kaempferol (7), and eupatorin (8), Of these compounds, quercetin and kaempferol were found to be the most potent ingredients. ConclusionThese findings collectively reveal that EAA exerts anti-inflammatory effects by both suppressing the NLRP3 priming step and protecting lysosomes to inhibit NLRP3 inflammasome activation, suggesting that this traditional herbal medicine might be used to treat NLRP3-driven inflammatory diseases.

Hepatitis E in immunocompromised individuals.

Hepatitis E virus (HEV) originally identified as a cause of acute icteric hepatitis in developing countries has grown to be a cause of zoonotic viral hepatitis in developed countries such as the United States. While there are eight identified genotypes to date, genotype 1 (HEV1), HEV2, HEV3, HEV4 are the most common to infect humans. HEV1 and HEV2 are most common in developing countries including Latina America, Africa and Asia, and are commonly transmitted through contaminated water supplies leading to regional outbreaks. In contrast HEV3 and HEV4 circulate freely in many mammalian animals and can lead to occasional transmission to humans through fecal contamination or consumption of undercooked meat. The incidence and prevalence of HEV in the United States is undetermined given the absence of FDA approved serological assays and the lack of commercially available testing. In majority of cases, HEV infection is a self-limiting hepatitis requiring only symptomatic treatment. However, this is not the case in immunocompromised individuals, including those that have undergone solid organ or stem cell transplantation. In this subset of patients, chronic infection can be life threatening as hepatic insult can lead to inflammation and fibrosis with subsequent cirrhosis and death. The need for re-transplantation as a result of post-transplant hepatitis is of great concern. In addition, there have been many reported incidents of extrahepatic manifestations, for which the exact mechanisms remain to be elucidated. The cornerstone of treatment in immunocompromised solid organ transplant recipients is reduction of immunosuppressive therapies, while attempting to minimize the risk of organ rejection. Subsequent treatment options include ribavirin, and pegylated interferon alpha in those who have demonstrated ribavirin resistance. Further investigation assessing safety and efficacy of anti-viral therapy is imperative given the rising global health burden. Given this concern, vaccination has been approved in China with other investigations underway throughout the world. In this review we introduce the epidemiology, diagnosis, clinical manifestations, and treatment of HEV, with emphasis on immunocompromised individuals in the United States.

A review of the genus Chrysosplenium as a traditional Tibetan medicine and its preparations

Ethnopharmacological relevancePlants of genus Chrysosplenium have a long history of application and are distributed in many countries, especially in Tibetan regions of China. The genus has been used locally in the treatment of various hepatobiliary diseases such as “Chiba disease” (related to cholecystitis, cholelithiasis, acute icteric hepatitis, and acute liver necrosis in modern medicine). Aim of the reviewThis review summarizes and critically analyzes the aspects of the botanical morphology and distribution, traditional uses, phytochemistry, pharmacological activities, quality control, and development status of preparations of the genus Chrysosplenium. Moreover, the future research direction and focus of the genus are also discussed. We hope to provide a valuable reference for researchers who are interested in the genus Chrysosplenium. Materials and methodsThe relevant information of the genus Chrysosplenium was gathered through electronic databases from 1968 to 2021, including PubMed, Web of Science, ScienceDirect, Google Scholar, Springer, CNKI, and Wan Fang, as well as PhD, MSc thesis, Chinese Pharmacopoeia (2020 edition), Tibetan medicine monographs. In addition, plant names were verified by “The Plant List” (The Plant List Database, http://www.theplantlist.org). ResultsBased on existing studies of chemical compositions, more than 90 compounds have been identified from Chrysosplenium species, including flavonoids, triterpenoids, volatile oils, steroids, alkaloids, and other compounds. The highly hydroxylated and methoxylated flavonoids and triterpenoids are the main active components. In addition, many studies have shown that the extracts and some components isolated from the genus Chrysosplenium have a variety of pharmacological activities, such as anti-tumor, antibacterial, anti-viral, hepatoprotective, and insecticidal properties. Furthermore, there are only 9 preparations with Chrysosplenium species as one of the medicinal materials. Among these preparations, C. nudicaule is used more and other Chrysosplenium species are rarely involved. ConclusionsMost medicinal species of Chrysosplenium have not only good therapeutic effects in traditional uses, but also a great potential for development in modern pharmaceutical studies. However, the material basis and mechanism of action of this genus have not been well explained. Therefore, further systematic and comprehensive research on the genus Chrysosplenium is still required to provide a scientific basis for its clinical applications.

Acupuncture treatment for acute icteric hepatitis

Objective: To observe the clinical efficacy of acupuncture treatment for acute icteric hepatitis. Method: Forty patients with acute icteric hepatitis were randomized into a treatment group and a control group (20 in each group). Oral liver-protecting medicine was administrated for the control group. In the treatment group, acupuncture with Yinlingquan-SP9, Yanglingquan-GB34, Zhusanli-ST36, Sanyinjiao-SP6, and Taichong-LR3 was added. The clinical efficacies and serum liver enzymes, including (TB, ALT, and GGT) were evaluated. Result: The total effective rate was 94.7% in the treatment group and 85.0% in the control group respectively, which differed significantly different(P<0.05). The liver function indexes decreased significantly in both groups after treatment (P<0.01). The indicators of the treatment group were significantly lower than those of the control group after treatment (P<0.05). Conclusion: Acupuncture combined with hepatoprotective drugs could be an effective method to treat acute jaundice hepatitis and showed better effectiveness than the single use of the conventional therapy.

COVID-19 Presenting as Acute Icteric Hepatitis

As the coronavirus pandemic continues to evolve, so does the understanding of different presentations of disease. In this case report, we describe a patient whose presentation of COVID-19 was with acute icteric hepatitis without respiratory symptoms. This is the first case in the literature to our knowledge to report jaundice as the initial presentation of disease and adds to just a handful of cases in the literature of acute hepatitis as the sole presentation of COVID-19. Additionally, despite severe hepatitis, the patient had a benign course of COVID-19 and did not require aggressive medical care; this strays from conventional paradigms that associate severity of COVID-19 with a degree of aminotransferase elevation. The purpose of this report is to make physicians aware of acute icteric hepatitis as a presentation of COVID-19 infection and to facilitate discussion and further research in the area of COVID-19-induced hepatitis.

Acute Severe Icteric Hepatitis Caused by the Novel Corona virus: A Case Report

Background: Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV-2) cases are being frequently reported nowadays and the objective of this clinical case report is to highlight its unique presentation as acute icteric sever hepatitis. Case report: A 28-year-old female patient presented with 3 days history of fever, abdominal pain, nausea, vomiting and jaundice. Lab investigations revealed positive COVID-19 reverse transcription-polymerase chain reaction test along with picture suggestive of acute severe hepatitis (Aspartate aminotransferase; 2772 U/L (N: <32), Alanine transaminase; 2522 U/L (N: <33), Alkaline phosphatase; 172 U/L (N: 35-104), direct bilirubin 4.2 mg/dl (N: 0-0.3)). The patient was admitted, monitored and started on supportive therapy for 5 days and was discharged well for outpatient follow-up. Conclusion: Requesting liver function test for COVID-19 patients who presents with gastrointestinal symptoms is a crucial decision that can guide us with the management of the case since many drugs used in the treatment of the new SARS‐CoV-2 infection are hepatotoxic and should therefore be used with caution. Keywords: Hepatitis, COVID-19, SARS‐CoV‐2, COVID-19 hepatitis, icteric hepatitis Citation: Al-Hasnawi DH, Kareem AM. Acute severe icteric hepatitis caused by the novel Corona virus: A case report. Iraqi JMS. 2021; 19(1): 56-59. doi: 10.22578/IJMS.19.1.8

The Traditional Uses, Phytochemistry, Pharmacology, Toxicology, and Clinical Uses of Metagentiana Rhodantha (Franch.) T.N.Ho and S.W.Liu, an Ethnomedicine in Southwest China.

Background: Metagentiana rhodantha (Franch.) T.N.Ho and S.W.Liu (MR) belongs to Gentianales, and it is often called Hong-hua-long-dan in Chinese. Traditionally, it has been used to cure acute icteric hepatitis, sore throat, dysentery, acute gastritis, carbuncle, and furuncle based on traditional Chinese medicine (TCM) concepts. Aim of Study: This review manages to provide a critical and comprehensive analysis on the traditional uses, phytochemistry, pharmacology, toxicology, and clinical uses of MR and to evaluate the therapeutic potential of this plant. Methods: Relevant data mainly literatures on MR were selected from available database. All the papers reviewed provided evidence that the source herbs were reliably identified. Results: The heat-clearing and removing the phlegm, and purging fire and removing toxicity of MR contribute to its dispelling jaundice, and clearing lung heat and cough. The compounds isolated from this plant include iridoids and secoiridoids, phenolic acids, ketones, triterpenoids, flavonoids, benzophenone glycosides, and others. Mangiferin (MAF) is a characteristic substance from this plant. The pharmacological studies show that some extracts and compounds from MR exhibit anti-inflammatory, antinociceptive, antibacterial, hepatoprotective, cardioprotective, and other effects which are associated with the traditional uses of this plant. The toxicological studies suggest that MAF is less toxic in mice and dogs. Nowadays, Chinese patent drugs such as Feilike Jiaonang and Kangfuling Jiaonang containing MR have been used to cure cough, asthma, chronic bronchitis, dysmenorrhea, and appendagitis. Conclusion: Although the current studies provide related research information of MR, it is still necessary to systemically evaluate the chemistry, pharmacology, toxicity, and safety of the extracts or compounds from this plant before clinical trials in the future. In addition, except for lung infection-related diseases, analgesia, anti-tumor, and hypertriglycemia may be new and prior therapeutic scopes of this ethnomedicine in the future.

2464 A Case of Acute Icteric Hepatitis Caused by Epstein Barr Virus in an Immunocompetent Adult

INTRODUCTION: Epstein Barr Virus (EBV) is a viral infection that can often remain asymptomatic but is also a major cause of infectious mononucleosis. Patients often present with sore throat, fever, lymphadenopathy and can develop splenomegaly. EBV-associated hepatitis is uncommon and cases with clinical jaundice are rare. CASE DESCRIPTION/METHODS: A 23-year old male without significant past medical history presented with one week of flu-like symptoms and acute onset of a generalized pruritic rash, right upper quadrant (RUQ) abdominal pain and dizziness. He denied any recent alcohol consumption, IV drug use or new medication initiation. On arrival to the emergency department the patient was afebrile with a blood pressure 130/84. Physical exam revealed scleral icterus and cutaneous jaundice, a diffuse macular rash was across his face, chest and arms and he had tender hepatomegaly. He was alert and oriented without confusion. Laboratory examination revealed a leukocytosis of 11.8, a total bilirubin of 15.8, direct bilirubin of 13.3, an INR of 1.2, ammonia of 26, an alkaline phosphatase of 499, and an ALT of 615 with AST of 405 signifying acute hepatitis. A urine drug screen was negative. A RUQ ultrasound with doppler showed no evidence of Budd-Chiari or portal vein thrombus; fatty infiltration of the liver was seen with no evidence of cholelithiasis or common bile duct obstruction. Hepatitis A, B and C viral screen was negative, acetaminophen level was within normal limits, HIV antibody test was negative, herpes virus IgM negative, CMV IgM negative, anti-smooth muscle antibody negative for autoimmune hepatitis. Ceruloplasmin and alpha-1 antitrypsin levels were not suggestive of Wilson's disease or alpha-1 antitrypsin deficiency. A peripheral smear showed reactive lymphocytosis. There was significant elevation in EBV IgM and heterophile antibody suggesting systemic Epstein Barr viral infection as the cause of acute hepatitis. Over the next 3 days, his liver enzymes began trending down slowly with symptomatic management and he was determined stable for discharge with plans for 2 and 4 week follow ups to monitor for resolving acute EBV hepatitis. DISCUSSION: It is important to remember that, although rare, EBV can cause hepatitis with diffuse jaundice and significant hyperbilirubinemia along with AST and ALT levels over 10 times the upper limit of normal. Such presentation could easily be misconstrued as an alternative diagnosis and patient safety compromised with unnecessary treatment.

THU-209 - Differentiation of acute icteric autoimmune hepatitis from idiosyncratic drug-induced liver injury by histological and biochemical criteria

THU-209 - Differentiation of acute icteric autoimmune hepatitis from idiosyncratic drug-induced liver injury by histological and biochemical criteria

A case of maternal death in a pregnant woman with fulminant hepatitis C

The article presents a description and analysis of a rare case of fulminant form of viral hepatitis C in a pregnant woman. A pregnant 24-year old patient (3d pregnancy, 1st delivery), was admitted to the hospital in a critical condition with suspected obstructive jaundice. As a result of diagnostic process the following diagnosis was made. Pregnancy, 36-37 weeks. Cephalic presentation. Antenatal intrauterine fetal death. Acute icteric viral hepatitis C, fulminant course. C-section was performed. In spite of fluid therapy during and after the surgery, the patient developed multiple organ failure which caused death. In spite of adequate resuscitation, the fulminant viral hepatitis C caused compromised liver function and multiple organ failure development, which became the cause of maternal death. We believe that intensified medical educational activity including nursing of the pregnant women and increased quality of other medical organizational activities are required that will lead to decreased maternal mortality rate on the periphery.

Review article: hepatitis E-a concise review of virology, epidemiology, clinical presentation and therapy.

Hepatitis E virus (HEV) is a leading cause of acute icteric hepatitis and acute liver failure in the developing world. During the last decade, there has been increasing recognition of autochthonous (locally acquired) HEV infection in developed countries. Chronic HEV infection is now recognised, and in transplant recipients this may lead to cirrhosis and organ failure. To detail current understanding of the molecular biology of HEV, diagnostic and therapeutic strategies and propose future directions for basic science and clinical research. PubMed was searched for English language articles using the key words "hepatitis E", "viral hepatitis", "autochthonous infection", "antiviral therapy", "liver transplantation", "acute", "chronic", "HEV", "genotype", "transmission" "food-borne", "transfusion". Additional relevant publications were identified from article reference lists. There has been increasing recognition of autochthonous HEV infection in Western countries, mainly associated with genotype 3. Chronic HEV infection has been recognised since 2008, and in transplant recipients this may lead to cirrhosis and organ failure. Modes of transmission include food-borne transmission, transfusion of blood products and solid organ transplantation. Ribavirin therapy is used to treat patients with chronic HEV infection, but new therapies are required as there have been reports of treatment failure with ribavirin. Autochthonous HEV infection is a clinical issue with increasing burden. Future work should focus on increasing awareness of HEV infection in the developed world, emphasising the need for clinicians to have a low threshold for HEV testing, particularly in immunosuppressed patients. Patients at potential risk of chronic HEV infection must also be educated and given advice regarding prevention of infection.

Qingre Lishi Tuihuang therapy for acute icteric hepatitis B: A systematic review

ObjectiveTo assess the efficacy of Qingre Lishi Tuihuang therapy (QLTT) for acute icteric hepatitis B infection. MethodsEight electronic databases were searched from inception to December 2016 with no language restrictions for reports of randomized controlled trials evaluating the effect of QLTT treating acute icteric hepatitis B. Two researchers independently extracted detailed data and assessed methodological quality. Review Manager 5.3.0 software was used to analyze the data. ResultsA total of 13 randomized controlled trials involving 2238 participants were included in this review. The methodological quality was generally poor. The results indicated that supplemented Yinchenhao decoction combined with non-specific treatments was more effective in improving the cure rate (risk ratio = 1.80; 95% CI 1.21–2.68) and reducing the serum levels of total bilirubin (mean difference = −29.74; 95% CI −31.91 to −27.57) and aspartate aminotransferase. Other self-made prescriptions conforming to QLTT plus non-specific treatments had beneficial effect for acute icteric hepatitis B in curing this disease (risk ratio = 1.48; 95% CI 1.27–1.73), as well as for negative seroconversion of HBeAg (risk ratio = 1.39; 95% CI 1.11–1.74). Supplemented Yinchenhao decoction plus non-specific treatments was more effective than other self-made prescriptions conforming to QLTT in reducing serum total bilirubin level. ConclusionQingre Lishi Tuihuang therapy appears to improve effect based on non-specific treatments for the treatment of acute icteric hepatitis B. However, it is premature to draw confirmative conclusions, owing to the poor methodological quality and high clinical heterogeneity of the included trials. Further well-designed clinical randomized controlled trials with large sample sizes should be undertaken.

Spontaneous Cirrhosis Regression in an IFN-beta-induced AIH-like Syndrome Following Drug Withdrawal: Art of Facts or Artifacts?

Autoimmune hepatitis (AIH) is a disease of unknown aetiology with drug-induced AIH being the most complex and not fully understood type. We present the case of a 57-year-old female patient with acute icteric hepatitis after interferon-beta-1b (IFNβ-1b) administration for multiple sclerosis (MS). Based on liver autoimmune serology, histology and appropriate exclusion of other liver diseases, a diagnosis of AIH-related cirrhosis was established. Following discontinuation of IFNβ-1b, a complete resolution of biochemical activity indices was observed and the patient remained untreated on her own decision. However, 3 years later, after a course of intravenous methylprednisolone for MS, a new acute transaminase flare was recorded which subsided again spontaneously after 3 weeks. Liver biopsy and elastography showed significant fibrosis regression (F2 fibrosis). To our knowledge, this is the first report showing spontaneous cirrhosis regression in an IFNβ-1b-induced AIH-like syndrome following drug withdrawal, suggesting that cirrhosis might be reversible if the offending fibrogenic stimulus is withdrawn.LEARNING POINTSAutoimmune hepatitis (AIH) is a very heterogeneous liver disease of unknown aetiology, with drug-induced AIH being the most complex and not fully understood type.Intravenous methylprednisolone pulse administration may reactivate or unmask previously unrecognised or misdiagnosed AIH and therefore liver autoimmune serology should be sought for every patient with acute or chronic hepatitis in the absence of viral, metabolic, genetic and alcoholic causes of liver disease.Spontaneous regression of cirrhosis, although controversial, may occur if the offending fibrogenic stimuli are immediately withdrawn as shown in this case of IFNβ-1b-induced AIH.

Acute icteric hepatitis as a presentation of Graves' thyrotoxicosis

Acute icteric hepatitis as a presentation of Graves' thyrotoxicosis

HCV-specific lymphocyte responses in individuals with positive anti-HCV but negative HCV-RNA

BackgroundHepatitis C virus (HCV) status cannot be reliably predicted in anti-HCV positive/HCV-RNA negative individuals who may either have recovered spontaneously or have a false-positive test due to antibody cross-reaction. Investigating T lymphocyte responses in individuals with different HCV status may help understand the cellular immune mechanisms underlying spontaneous recovery, treatment response, and chronicity. ObjectiveWe aimed to determine whether anti-HCV positive, HCV-RNA negative individuals are truly spontaneous recoverers from acute HCV infection. Study designWe used enzyme-linked immunosorbent spot (ELISPOT) assay to compare HCV-specific lymphocyte response among anti-HCV positive/HCV-RNA negative individuals, patients with sustained virological response to interferon-γ/ribavirin treatment, and patients with chronic HCV infection. ResultsWe found that 83% of anti-HCV positive/HCV-RNA negative individuals without a past medical history of acute icteric hepatitis had an HCV-specific T lymphocyte response in peripheral blood. Lymphocyte responses in these individuals were similar in magnitude to treatment responders unlike patients with chronic HCV whose virus-directed immunity was significantly suppressed. ConclusionsDetection of HCV-specific T lymphocyte responses using ELISPOT is a feasible method to ascertain past asymptomatic acute HCV infection.

Progress of phytochemicals, pharmacological effects and clinical applications on Cotinuscoggygria Scop

Cotinus coggygria Scop. is the Anacardiaceae Cotinus L. plant and used for natural drugs in the treatment of acute icteric infectious hepatitis. The pharmacological research showed that Cotinus coggygria Scop. has the effects of reducing jaundice and enzyme, gallbladder Cholagogic and strengthen immune function. The current research on Cotinus coggygria Scop. is still not deep enough, the pharmacological effects of Cotinuscoggygria Scop. are mostly limited to the anticoagulant, hemolytic and anti liver chemical injury. In order to better study the scientific connotation of antitumor of Cotinus coggygria Scop., the active ingredient of Cotinuscoggygria Scop., pharmacological action and clinical application were reviewed. Key words: Cotinus coggygria Scop.; Phytochemicals; Pharmacological action; Clinical application