1 / 21

Case Report AK 07.07.2005 Liver biopsy total length 6 mm suggestiv for autoimmune hepatitis

Case Report AK 07.07.2005 Liver biopsy total length 6 mm suggestiv for autoimmune hepatitis Steroid- induced hepatitis Toxic hepatitis. Case Report AK 07.07.2005. Case Report AK female 07.07.2005. Case Report AK female 07.07.2005. Case Report AK female 07.07.2005.

armand
Download Presentation

Case Report AK 07.07.2005 Liver biopsy total length 6 mm suggestiv for autoimmune hepatitis

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Case Report AK 07.07.2005 • Liverbiopsy • total length 6 mm • suggestiv for • autoimmune hepatitis • Steroid-inducedhepatitis • Toxichepatitis

  2. Case Report AK 07.07.2005

  3. Case Report AK female07.07.2005

  4. Case Report AK female 07.07.2005

  5. Case Report AK female 07.07.2005

  6. Case Report AK female 07.07.2005

  7. Case Report AK female 07.07.2005

  8. Case Report AK female 07.07.2005

  9. Case Report AK female 07.07.2005

  10. Immunohistochemistryfor CD38-positive plasmacellsand CD3-positive and CD8-positive T-cells CD38 forplasmacells CD3 for T-cells Case Report AK female 07.07.2005 CD8 for T-cells

  11. Case Report AK female 07.07.2005 differentiationbetween autoimmune hepatitis and drug-inducedliverdamage on basisofmorphologywithoutclinicaldata not possible

  12. Having knowledgeof total clinicaldata presentedbytheclinician: Morphologicaldiagnosis: Highly suggestive for Drug-inducedliverinjury (DILI) after steroidexposuresomemonthsbeforetherapy Preexisting autoimmune hepatitis not tobeexcluded (a form ofoverlap-syndrom AIH/DILI ?)

  13. Suggestive mechanismsandtargetsoftoxicliverinjury Membrane lesion Transport mechanism (pump) Endoplasmaticreticulum Triggeringof T-cellreactionbymembranetargeting Activationofapoptoticpathwayby TNF-alpha-factor Mitochondrialdamage Modifyied after Lee WM (2003) N ENGL J MED 349,5

  14. Pathogeneticalclassificationofdrug-inducedliverinjury • Intrinsicmechanism • Directinjuryofhepatocytes (dosis-dependent) • Indirectinjuryofhepatocytes (dosis-dependent) • 2. Idiosyncraticmechanism • Immunologicmechanism – allergicreaction, fever, • exanthema, eosinophilia • Metabolicmechanism – mostly via covalentbindingstoproteinsinduce an immunologicalreaction

  15. Drug-inducedliverinjuries • Highly variable changesoflivertisssue • Minimal changes in portaltractsorintralobular • Severechanges in portaltractsorintralobular • Non-alcoholicsteatohepatitis • Autoimmune hepatitis • Acuteandchronicinflammationoftheliver • Cholestasis • Acuteliverfailure • cirrhosis

  16. Drug-inducedliverinjuries • Nospecificpatternofinjuryofthelivertissue • Difficult differential diagnosing • Histologicallygreatresemblanceto viral inducedhepatitis • Occasionaloccurenceofantibodies (e.g. ANA, SMA)

  17. from: Rhen T, Cidlowski JA NEngl JMed (2005) 353, p 1713

  18. possible clinical course and suggestion: primary mild autoimmune hepatitis – followed by corticoid-therapie – followed by severe drug-induced liver injury („overlap-syndrom AIH/DILI”) Hepatitis-E can not be excluded ???

  19. Case Report AK female 07.07.2005

  20. Case Report AK female 07.07.2005

More Related