Abstract
A 69-year-old Japanese female was admitted because of general fatigue. Laboratory data showed elevation of serum total bilirubin, transaminase, gamma-glutamyl transpeptidase, and creatinine levels. An immunological study revealed hypergammaglo-bulinemia, low titer of complement, and high titers of antinuclear antibody, anti-DNA antibody, and circulating immune complexes. Antibodies to parainfluenza virus 3 were positive. Histology of the liver disclosed numerous giant cell hepatocyte transformations with the lobular architecture being slightly distorted by portal inflammation and fibrosis. These findings led us to make a diagnosis of giant cell hepatitis associated with systemic lupus erythematosus. Prednisolone was effective in improving the anemia and the serum immunoglobulin, immune complex, and antinuclear antibody levels. The addition of cyclosporine to the initial corticosteroid therapy was also beneficial in decreasing the transaminase level and in improving liver histology. The patient died of acute pneumonitis and renal failure on the 166th day after admission. Parainfluenza virus 3 and autoimmune mechanisms were thus considered to be the causes of the giant cell hepatitis.
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References
Devaney K, Goodman ZD, Ishak KG. Postinfantile giant-cell transformation in hepatitis. Hepatology 1992;16:327–333.
Greco MA, Finegold MJ. Familial giant cell hepatitis. Report of two cases and review of the literature. Arch Pathol 1973;95: 240–244.
Richey J, Rogers S, Van Thiel DH, et al. Giant multinucleated hepatocytes in an adult with chronic active hepatitis. Gastroenterology 1977;73:570–574.
Pessayre D, Degos F, Feldmann G, et al. Chronic active hepatitis and giant multinucleated hepatocytes in adults treated with clometacin. Digestion 1981;22:66–72.
Shinozaki T, Saito K, Shiraki K. HBsAg-positive giant cell hepatitis with cirrhosis in a 10-month-old infant. Arch Dis Child 1981;56:64–74.
Schmid M, Pirovino M, Altorfer J, et al. Acute hepatitis non-A, non-B; are there any specific light microscopic features? Liver 1982;2:61–67.
Spichtin HP, Gudat F, Schmid M, et al. Microtubular aggreates in human chronic non-A, non-B hepatitis with bridging hepatic necrosis and multinucleated hepatocytic giant cells. Liver 1982; 2:355–360.
De Vos R, Vanstapel MJ, Desmyter J, et al. Are nuclear particles specific for non-A, non-B hepatitis. Hepatology 1983; 3:532–544.
Witzleben CL, Marshall GS, Wenner W, et al. HIV as a cause of giant cell hepatitis. Hum Pathol 1988;19:603–605.
Aikat BK, Bhattacharya T, Datta DV. Grant cell hepatitis with cytomegalovirus inclusions in an adult. A case report. J Assoc Phys India 1974;22:63–66.
Phillips MJ, Blendis LM, Poucell S, et al. Syncytial giant-cell hepatitis. Sporadic hepatitis with distinctive pathological features, a severe clinical course, and paramyxoviral features. N Engl J Med 1991;324:455–460.
Lau JYN, Koukoulis G, Mieli-Vergani G, et al. Syncytial giant-cell hepatitis—a specific disease entity? J Hepatology 1992;15: 216–219.
Kobayashi K, Hashimoto E, Taniai M, et al. A case of post-infantile giant cell hepatitis with positive LE cell, antinuclear antibody (in Japanese). Acta Hepatol Jpn 1993;34:239–243.
Montgomery CK, Ruebner BH. Neonatal hepatocellular giant cell transformation: A review. In: Rosenberg HS, Bolande RP (eds) Perspectives in pediatric pathology, vol 3. Chicago: Year Book Medical 1983;85:85–101.
Thaler H. Post-infantile giant cell hepatitis. Liver 1982;2:393–403.
Pinkerton H, Smiley WL, Anderson WAD. Giant cell pneumonia with inclusions: A lesion common to Hecht's disease, distemper, and measles. Am J Pathol 1945;21:1–23.
Breitfeld V, Hashida Y, Sherman FE et al. Fatal measles infection in children with leukemia. Lab Invest 1973;28:279–291.
Robertson DAF, Zhang SL, Guy EC, et al. Persistent measles virus genome in autoimmune chronic active hepatitis. Lancet 1987;2:9–11.
Brichard B, Sokal E, Gosseye S, et al. Coombs-positive giant cell hepatitis of infancy: Effect of steroids and azathioprine therapy. Eur J Pediatr 1991;150:314–317.
Thaler MM. Cryptogenic liver disease in young infants. In: Popper H, Schaffner F (eds) Progress in liver disease, vol 5. New York: Grune and Stratton, 1976;476–493.
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Dohmen, K., Ohtsuka, S., Nakamura, H. et al. Post-infantile giant cell hepatitis in an elderly female patient with systemic lupus erythematosus. J Gastroenterol 29, 362–368 (1994). https://doi.org/10.1007/BF02358378
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DOI: https://doi.org/10.1007/BF02358378