Recurrent severe acute hepatitis caused by hypereosinophilic syndrome associated with elevated serum immunoglobulin G4 levels

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• 作者：Tomonori Aoyama (1)
  Toshiharu Matsumoto (2)
  Akira Uchiyama (1)
  Kazuyoshi Kon (1)
  Shunhei Yamashina (1)
  Satoko Suzuki (1)
  Kenichi Ikejima (1)
  Takashi Yao (3)
  Ryohei Kuwatsuru (4)
  Sumio Watanabe (1)
  
• 关键词：Eosinophilia ; IgG4 ; Acute hepatitis
• 刊名：Clinical Journal of Gastroenterology
• 出版年：2014
• 出版时间：December 2014
• 年：2014
• 卷：7
• 期：6
• 页码：516-522
• 全文大小：1,033 KB
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• 作者单位：Tomonori Aoyama (1)
  Toshiharu Matsumoto (2)
  Akira Uchiyama (1)
  Kazuyoshi Kon (1)
  Shunhei Yamashina (1)
  Satoko Suzuki (1)
  Kenichi Ikejima (1)
  Takashi Yao (3)
  Ryohei Kuwatsuru (4)
  Sumio Watanabe (1)
  
  1. Department of Gastroenterology, Juntendo University School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
  2. Department of Clinical Pathology, Juntendo University Nerima Hospital, Tokyo, Japan
  3. Department of Human Pathology, Juntendo University School of Medicine, Tokyo, Japan
  4. Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan
  
• ISSN：1865-7265

文摘

A 46-year-old male was admitted to our hospital with severe acute hepatitis, hypereosinophilia, and serum immunoglobulin G4 (IgG4) elevation. Plasma exchange was performed, and he was treated by prednisolone; however, his hepatitis recurred twice over the following twelve months. Transjuglar liver biopsy was performed at the third onset, which demonstrated extensive hepatocyte necrosis, congestion, and severe eosinophil infiltration. We diagnosed hypereosinophilic syndrome (HES)-related hepatitis. Although no cholangitis was detected by imaging and pathological diagnosis, IgG4-positive cells were detected in the liver and bone marrow. Furthermore, the elevation of serum IgG4 levels was associated with the eosinophil count and his clinical condition. After the addition of azathioprine to his treatment regimen, no reoccurrence was observed. IgG4-positive cells may have contributed to the severity and refractoriness of this recurrent acute HES-related hepatitis.