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[(罕见)传染性肝炎作为不明原因肝病的重要鉴别诊断]

[(Rare) infectious hepatitis as an important differential diagnosis of unclear hepatopathy].

作者信息

Wührl Michael, Ringelhan Marc, Ehmer Ursula, Schneider Jochen, Kager Juliane, Lahmer Tobias, Schneider Anna, Weichert Wilko, Mogler Carolin

机构信息

Institut für allgemeine Pathologie und pathologische Anatomie, Technische Universität München, Trogerstr. 18, 81675, München, Deutschland.

Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Technische Universität München, München, Deutschland.

出版信息

Pathologie (Heidelb). 2023 Feb;44(1):53-62. doi: 10.1007/s00292-022-01167-0. Epub 2022 Dec 1.

Abstract

BACKGROUND

Liver biopsies to determine the cause of unclear hepatopathy and acute liver failure represent a diagnostic hallmark and require close cooperation between clinicians and pathologists. The commonly acute presentation of hepatic dysfunction warrants a rapid diagnosis. Infectious causes of hepatitis may be identified by the pathologist, supporting further diagnostic and therapeutic steps.

OBJECTIVES

Rare infectious causes of hepatic dysfunction with distinct histomorphological features are presented.

MATERIALS AND METHODS

Retrospective cases of liver biopsies for evaluation of hepatic dysfunction with infection confirmed by laboratory tests were selected from the archive of the institute of pathology of TUM and evaluated for morphologic diagnostic criteria.

RESULTS AND CONCLUSIONS

Infections with adenovirus, Herpes simplex virus, Hepatitis A virus, and coxiella burnettii are rare findings in liver core biopsies but able to cause hepatic dysfunction that present with distinct histomorphologic alterations that can contribute to the identification of the causative agent. Rare infectious causes should be considered in any patient presenting with hepatic dysfunction of unknown etiology. Knowledge of the histomorphologic criteria by the pathologist is crucial to initiate further diagnostic testing and treatment.

摘要

背景

肝活检用于确定不明原因肝病和急性肝衰竭的病因,是一项诊断标志,需要临床医生和病理学家密切合作。肝功能障碍通常呈急性表现,需要快速诊断。病理学家可识别肝炎的感染病因,为进一步的诊断和治疗步骤提供支持。

目的

介绍具有独特组织形态学特征的罕见肝功能障碍感染病因。

材料与方法

从慕尼黑工业大学病理研究所档案中选取经实验室检查确诊感染且用于评估肝功能障碍的肝活检回顾性病例,并对形态学诊断标准进行评估。

结果与结论

腺病毒、单纯疱疹病毒、甲型肝炎病毒和伯氏考克斯体感染在肝芯活检中较为罕见,但可导致肝功能障碍,并呈现出独特的组织形态学改变,有助于识别病原体。对于任何病因不明的肝功能障碍患者,均应考虑罕见感染病因。病理学家了解组织形态学标准对于启动进一步的诊断检测和治疗至关重要。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2530/9877095/842ba08e9943/292_2022_1167_Fig1_HTML.jpg

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