Shinzato Takahiro, Kubo Taro, Shimizu Toshihiro, Nanmoku Koji, Yagisawa Takashi
Department of Renal Surgery and Transplantation, Jichi Medical University Hospital, 3311-1 Yakushiji, Shimotsuke, Tochigi, 3290498, Japan.
CEN Case Rep. 2019 May;8(2):101-105. doi: 10.1007/s13730-018-0374-6. Epub 2019 Jan 2.
Fibrosing cholestatic hepatitis (FCH) is a fatal disorder that presents as a progressive deterioration of liver function over a period of several weeks to several months. It is caused by the direct cytotoxic effect of the over-expression of viral antigens on hepatocytes in immunosuppressed patients. Our patient was a 59-year-old man with hepatitis C virus (HCV) infection of genotype 2a who had suffered from end-stage renal disease due to diabetic nephropathy and underwent kidney transplantation. His serum total bilirubin levels gradually increased to 20 mg/dl and liver atrophy progressed during several weeks after kidney transplantation, which was initially difficult to distinguish from drug-induced liver injury. We diagnosed the condition as FCH on the basis of pathological findings and increased HCV viral load, and treated the patient with Glecaprevir/Pibrentasvir. However, the patient died of refractory hemorrhagic gastric ulcer and liver failure. Currently, it is possible to treat infections of all genotypes of HCV, even with end-stage renal disease, with direct acting antivirals. Furthermore, it is preferable to treat HCV before kidney transplantation considering the risk of FCH due to immunosuppressive therapy.
纤维化淤胆型肝炎（FCH）是一种致命性疾病，表现为肝功能在数周数月内进行性恶化。它是由免疫抑制患者中病毒抗原过度表达对肝细胞产生的直接细胞毒性作用所引起。我们的患者是一名59岁男性，丙型肝炎病毒（HCV）2a基因型感染，因糖尿病肾病患有终末期肾病并接受了肾移植。肾移植后数周内，他的血清总胆红素水平逐渐升至20mg/dl，肝脏萎缩进展，最初难以与药物性肝损伤相鉴别。我们根据病理结果和HCV病毒载量升高诊断该疾病为FCH，并使用格卡瑞韦/哌仑他韦治疗该患者。然而，患者死于难治性出血性胃溃疡和肝衰竭。目前，即使是终末期肾病患者，使用直接抗病毒药物也能够治疗所有基因型的HCV感染。此外，考虑到免疫抑制治疗导致FCH的风险，在肾移植前治疗HCV更为可取。
