RESUMEN
A hepatitis C virus (HCV) chronically infected patient developed an episode of acute hepatitis during the course of immunosuppressive therapy given for a lymphoproliferative disease. It was noted that anti-HCV antibody response, seen to be relatively stable during the follow-up, lowered dramatically in coincidence with the hepatocytolytic peak. A diagnostic liver biopsy taken at the time of the acute phase of hepatitis demonstrated a typical feature of lobular hepatitis with widespread lymphocytic infiltrates, the predominant type of which expressed CD8 immunophenotype. Cytotoxic and immunosuppressive drugs may interfere with hepatitis virus infections. However, at variance from hepatitis B virus infection in which acute liver decompensation develops after withdrawal of chemotherapy in our HCV chronically infected patient it appeared during the course of the treatment, suggesting a different hepatocytolytic mechanism. Although the actual frequency of the phenomenon is presently unknown, this observation seems to indicate that immunosuppressive and cytotoxic agents should be used with caution in HCV chronic infection in which cell-mediated immune response seems to play a major role in the production of the liver damage.
Asunto(s)
Hepacivirus/inmunología , Hepatitis C/inmunología , Leucemia Linfocítica Crónica de Células B/inmunología , Enfermedad Aguda , Complejo Antígeno-Anticuerpo/análisis , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Inmunidad Celular , Inmunohistoquímica , Cinética , Leucemia Linfocítica Crónica de Células B/patología , Persona de Mediana EdadAsunto(s)
Antagonistas Adrenérgicos beta/uso terapéutico , Antihipertensivos/uso terapéutico , Hidroclorotiazida/análogos & derivados , Hipertensión/tratamiento farmacológico , Metipranolol/administración & dosificación , Propanolaminas/administración & dosificación , Inhibidores de los Simportadores del Cloruro de Sodio/uso terapéutico , Adulto , Anciano , Diuréticos , Combinación de Medicamentos , Femenino , Humanos , Hidroclorotiazida/administración & dosificación , Masculino , Persona de Mediana EdadAsunto(s)
Fructosa/farmacología , Ácido Úrico/sangre , Femenino , Humanos , Masculino , Ácido Úrico/orinaRESUMEN
A case of bullous pneumopathy in an elderly subject is reported. The particular localization of the pneumonic process at the base of the left lung led to an initial suspicion of diaphragmatic relaxation. Subsequent development and the onset of pneumatoceles within the non-infiltrated pulmonary parenchyma led to a definite diagnosis of bullous pneumopathy which, from its clinico-radiological course, was attributed to a staphylococcic aetiology. Toxic-infective state with leucocytosis and polynucleosis; variability of radiological pictures; early pleural picture; sensitivity to Cephaloridine (which in the present case probably confined the condition to the left lung only); the benign course of the disease; all these elements pointed to staphylococcic bullous pneumopathy in the absence of any cultural demonstration. The different disease conditions in which pneumatoceles occur are reviewed along with the possible mechanisms for their formation.