Topaloğlu Serdar, Çalık Adnan, Kalaycı Orhan, Çeşmecioğlu Emine, Çobanoğlu Ümit, Uzun Yusuf
Department of Surgery, Karadeniz Technical University, School of Medicine, Farabi Hospital, Trabzon, Turkey.
Exp Clin Transplant. 2014 Mar;12 Suppl 1:95-7.
Fibrosing cholestatic hepatitis is an aggressive and usually fatal form of viral hepatitis in immunosuppressed patients. We assessed the hepatotoxicity of methotrexate and prednisolone combination therapy in the background of hepatitis B virus infection.
We report the clinical course of a 55-year-old woman who underwent a deceased-donor liver transplant for fulminant liver failure.
The patient's medical history was significant for hepatitis B virus infection and rheumatoid arthritis. Methotrexate and prednisolone combination therapy were started 5 months earlier. The patient was hospitalized because of an elevation in her liver enzymes and total bilirubin. Deterioration of liver functions and encephalopathy were developed 5 weeks after hospital admission. A deceased-donor liver transplant was performed, and pathological examination of recipient liver revealed fibrosing cholestatic hepatitis. The patient was reoperated on for bile leak and discharged 40 days after the deceased-donor liver transplant.
The natural course of the current case was similar to previously reported cases with fibrosing cholestatic hepatitis. Clinicians should consider the potential hepatotoxicity of methotrexate and steroid therapy in hepatitis B virus infected patients.
纤维性胆汁淤积性肝炎是免疫抑制患者中一种侵袭性且通常致命的病毒性肝炎形式。我们评估了在乙型肝炎病毒感染背景下甲氨蝶呤和泼尼松龙联合治疗的肝毒性。
我们报告了一名55岁女性的临床病程，该患者因暴发性肝衰竭接受了已故供体肝移植。
患者的病史有乙型肝炎病毒感染和类风湿性关节炎。甲氨蝶呤和泼尼松龙联合治疗于5个月前开始。患者因肝酶和总胆红素升高而住院。入院5周后出现肝功能恶化和肝性脑病。进行了已故供体肝移植，受体肝脏的病理检查显示为纤维性胆汁淤积性肝炎。患者因胆漏再次手术，并在已故供体肝移植后40天出院。
本病例的自然病程与先前报道的纤维性胆汁淤积性肝炎病例相似。临床医生应考虑甲氨蝶呤和类固醇治疗对乙型肝炎病毒感染患者的潜在肝毒性。
