Mulder Christopher J, Cho Ryan S, Harrison Stephen A, Cebe Katherine, Francis James M
Department of Gastroenterology, Brooke Army Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234.
Department of Internal Medicine, Brooke Army Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234.
Mil Med. 2015 May;180(5):e611-3. doi: 10.7205/MILMED-D-14-00530.
Giant cell hepatitis is a rare entity in adults, accounting for 0.1% to 0.25% of liver disease in adults. Postinfantile giant cell hepatitis is often characterized by multinucleated giant cells on liver biopsy and a fulminant hepatitis.
An active duty 36-year-old African-American male deployed to Kabul, Afghanistan, presented with jaundice 2 weeks after starting a testosterone analogue. He discontinued the supplement, but his jaundice persisted with up-trending bilirubin. Serologic testing was negative for hepatitis A, B, C, and E; cytomegalovirus; Epstein-Barr virus; herpes simplex virus; and human immunodeficiency virus. Evaluation for autoimmune hepatitis was negative. Magnetic resonance cholangiopancreatography was negative for obstruction. Liver biopsy revealed giant cell transformation of numerous hepatocytes and cholestatic hepatitis. Rapid plasma reagin was positive without physical findings. Treponema pallidum hemagglutination assays confirmed the diagnosis of latent syphilis. He was started on penicillin treatment with rapid improvement of bilirubin, creatinine, and hepatic synthetic function, all of which eventually normalized.
Postinfantile giant cell hepatitis is a severe form of hepatitis that has several different potential etiologies, 2 of which were present in this patient: androgenic supplements and infection. This case highlights syphilis as an unusual but treatable cause of giant cell hepatitis. Testing for syphilis should be considered in any persistent liver injury.
巨细胞性肝炎在成人中较为罕见，占成人肝病的0.1%至0.25%。婴儿期后巨细胞性肝炎通常以肝活检显示多核巨细胞和暴发性肝炎为特征。
一名36岁现役非裔美国男性，被部署到阿富汗喀布尔，在开始使用睾酮类似物2周后出现黄疸。他停用了该补充剂，但黄疸持续存在且胆红素呈上升趋势。甲型、乙型、丙型和戊型肝炎、巨细胞病毒、爱泼斯坦-巴尔病毒、单纯疱疹病毒及人类免疫缺陷病毒的血清学检测均为阴性。自身免疫性肝炎评估为阴性。磁共振胰胆管造影显示无梗阻。肝活检显示大量肝细胞巨细胞转化及胆汁淤积性肝炎。快速血浆反应素试验呈阳性但无体征。梅毒螺旋体血凝试验确诊为潜伏梅毒。他开始接受青霉素治疗，胆红素、肌酐及肝脏合成功能迅速改善，最终均恢复正常。
婴儿期后巨细胞性肝炎是一种严重的肝炎形式，有几种不同的潜在病因，该患者存在其中两种：雄激素补充剂和感染。本病例突出了梅毒作为巨细胞性肝炎一种不常见但可治疗病因的情况。对于任何持续性肝损伤均应考虑进行梅毒检测。
