Sehdev Ann E, Dumler J Stephen
Dept of Pathology, Johns Hopkins Medical Institutions, Meyer B1-193, 600 N Wolfe St, Baltimore, MD 21287, USA.
Am J Clin Pathol. 2003 Jun;119(6):859-65. doi: 10.1309/F7EA-B5P7-3217-16LJ.
Ehrlichia chaffeensis causes human monocytic ehrlichiosis (HME) that usually includes fever, myalgias, and pancytopenia and, in 80% to 90% of patients, elevations in serum transaminase levels. Thus, the pathology of liver injury was studied in liver tissues from 7 patients with laboratory-confirmed HME. H&E and immunohistochemical stains for E chaffeensis and leukocyte markers were examined. Scattered lobular lymphohistiocytic foci and diffuse lymphohistiocytic infiltration and Kupffer cell hyperplasia with increased phagocytosis frequently were present. Various degrees of liver cell injury and death were observed. Cholestasis was evident in 6 cases, sometimes with bile duct epithelial injury. Rare to abundant E chaffeensis-infected mononuclear cells infiltrating lobules or portal regions or in Kupffer cells were observed in 5 patients. The inflammation was out of proportion to the infection in 6 cases. In the absence of infected hepatocytes or biliary epithelial cells, these findings suggest that host inflammatory or immune responses contribute to the liver injury seen in HME.
查菲埃立克体可引起人单核细胞埃立克体病（HME），该病通常包括发热、肌痛和全血细胞减少，80%至90%的患者血清转氨酶水平会升高。因此，对7例实验室确诊为HME的患者的肝脏组织进行了肝损伤病理学研究。检查了查菲埃立克体和白细胞标志物的苏木精-伊红染色及免疫组织化学染色。经常可见散在的小叶淋巴细胞-组织细胞灶、弥漫性淋巴细胞-组织细胞浸润以及库普弗细胞增生伴吞噬作用增强。观察到不同程度的肝细胞损伤和死亡。6例可见胆汁淤积，有时伴有胆管上皮损伤。5例患者观察到有罕见至大量感染查菲埃立克体的单核细胞浸润小叶或门区或存在于库普弗细胞中。6例的炎症与感染程度不相称。在没有感染的肝细胞或胆管上皮细胞的情况下，这些发现提示宿主的炎症或免疫反应导致了HME中所见的肝损伤。
