Letter to the Editor
Post-infantile giant cell hepatitis
Hepatitis de células gigantes post-infantil
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(b) Masson's trichrome staining highlighting septal fibrosis (arrowheads), demarcating regenerative nodules, consistent with definitive cirrhosis (Ishak score 6); (c) Presence of septal and intralobular lymphocyte-predominant inflammatory infiltrate (arrows) and focal hepatocellular necrosis (dashed circle) (H&E, 100×); (d) Multinucleated giant hepatocytes (arrows) and mild interface hepatitis (asterisk) (H&E, 200×); (e) Multinucleated giant hepatocytes (arrows), having more than 4–5 nuclei, and the aforementioned features of hepatitis, allowing the diagnosis of PIGCH. Eosinophils are also noted (arrowhead) (H&E, 400×).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Giant cell hepatitis is commonly observed in pediatric hepatic diseases. Post-infantile giant cell hepatitis (PIGCH), the adult form, is rather rare, constituting merely 0.1–0.25% of adult liver diseases.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,2</span></a> We report a case of PIGCH with rapid progression to cirrhosis, featuring a potential new culprit.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 22-year-old male was referred for elevated liver enzymes on routine blood tests showing a cytolysis predominant pattern with aspartate aminotransferase of 139<span class="elsevierStyleHsp" style=""></span>IU/L (normal range value [RV]<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>40<span class="elsevierStyleHsp" style=""></span>IU/L), alanine aminotransferase of 476<span class="elsevierStyleHsp" style=""></span>IU/L (RV<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>55<span class="elsevierStyleHsp" style=""></span>IU/L), gamma-glutamyl transpeptidase of 135<span class="elsevierStyleHsp" style=""></span>IU/L (RV<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>64<span class="elsevierStyleHsp" style=""></span>IU/L), normal alkaline phosphatase and total bilirubin. He had no previous medical history, apart from Coronavirus disease 19 (COVID-19) two months prior to the laboratory assessment, which had a mild symptomatic course, not requiring medical care. Apart from this period, he was completely asymptomatic. He denied any chronic medication, recent introduction of drugs or herbal products, or any epidemiology suggestive of zoonotic diseases. Blood analyses from the previous year had normal liver values.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The patient had a good general status, being physical examination unremarkable. Subsequent laboratory assessment, following two months, showed overlapping values of liver enzymes, with preserved liver function. An abdominal ultrasound and contrast-enhanced computed tomography identified mild steatotic hepatomegaly and slight splenomegaly, excluding focal lesions, biliary lithiasis, thrombosis or other complications of the portosplenomesenteric territory. An extensive blood work-up excluded hepatotropic infectious agents, metabolic causes, immune-mediated liver diseases, and systemic autoimmune diseases and hematological disorders with potential hepatic involvement (detailed in <a class="elsevierStyleCrossRef" href="#sec0020">Supplementary table</a>). Past infection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was documented by serology and negative viral load.</p><p id="par0020" class="elsevierStylePara elsevierViewall">After 8 months of persistent liver cytolysis, mild thrombocytopenia (111<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">3</span>/μL) and hyperbilirubinemia (1.8<span class="elsevierStyleHsp" style=""></span>mg/dL) arose. Given the inconclusive etiological investigation, an ultrasound-guided percutaneous liver biopsy was undertaken, documenting liver cirrhosis. The remarkable presence of numerous multinucleated giant hepatocytes along with features of hepatitis, namely lymphocyte-predominant inflammatory infiltrate, mild interface hepatitis and focal hepatocellular necrosis, allowed the diagnosis of PIGCH, already in cirrhotic phase (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). No histopathological findings suggestive of an underlying etiology for PIGCH were noted.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The patient was referred to a liver transplant center, remaining asymptomatic, with no signs of hepatic decompensation at one year follow-up, despite continued elevation of liver enzymes.</p><p id="par0030" class="elsevierStylePara elsevierViewall">PIGCH has fewer than 200 cases reported in the literature.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,2</span></a> Immuno-mediated diseases, mainly autoimmune hepatitis, constitute the primary cause (30–40% of the cases). Less frequently, PIGCH has also been described in primary biliary and primary sclerosing cholangitis, ulcerative colitis, Sjogren's syndrome, systemic lupus erythematous, rheumatoid arthritis and polyarteritis nodosa.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,3,4</span></a> Hepatotropic viruses comprise 20% of the causes, such as hepatitis A, B, C and E viruses, cytomegalovirus, Epstein–Barr, herpes simplex and human herpes 6 viruses.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> In 10–12% of the cases, medications are found to be the causative agent. Methotrexate, 6-mercaptopurine, amitriptyline, chlorpromazine, diclofenac, androgenic analogs, as well as herbal remedies and dietary supplements, were reported in association with PIGCH.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,2,4</span></a> Hematological disorders, particularly chronic lymphocytic leukemia, but also lymphoma and autoimmune hemolytic anemia have been tied to the development of PIGCH (7–8% of the cases). While some patients may have more than one contributing etiology for PIGCH, no predisposing factor is found in 10–30% of the cases.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,3,4</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Disease presentation is highly variable, ranging from mild asymptomatic elevations in liver enzymes to cirrhosis or acute liver failure, demanding liver transplantation.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Diagnosis of PIGCH requires liver biopsy with documentation of giant multinucleated hepatocytes along with features of hepatitis such as inflammation, lobular disarray, Kupffer cell hypertrophy or focal hepatocellular necrosis.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Management of PIGCH is still a matter of debate, but treatment of the underlying cause, especially if autoimmune or viral, can result in clinical stability.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,3</span></a> Idiopathic PIGCH has a poor prognosis, frequently requiring liver transplant. Unfortunately, post-transplant recurrence of PIGCH has been documented.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Our case highlights a rare presentation, remaining idiopathic despite thorough investigation. Nevertheless, the lymphocyte-predominant infiltrate on liver biopsy, often suggestive of a viral etiology, and the temporal correlation between the elevation of liver enzymes and SARS-CoV-2 infection make it challenging to dismiss the potential contribution of this virus. A single case of fatal acute liver failure with presence of giant cell hepatitis in an infant with COVID-19-associated multisystem inflammatory syndrome has been reported.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> To our knowledge, this is the first case reporting SARS-CoV-2 as a potential trigger of PIGCH.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical considerations</span><p id="par0050" class="elsevierStylePara elsevierViewall">The present publication upholds confidentiality by not providing any information regarding the patient's identity. Informed consent for this publication was obtained from the patient for publication of this case report and accompanying figures.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Funding</span><p id="par0055" class="elsevierStylePara elsevierViewall">No financial support was provided for this publication.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Ethical considerations" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Funding" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0070" class="elsevierStylePara elsevierViewall">The following are the supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0025" ] ] ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1570 "Ancho" => 3175 "Tamanyo" => 981182 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Liver biopsy histopathological examination: (a) Liver parenchyma with regenerative nodules with multinucleated giant hepatocytes (arrows), mainly in periseptal zones (H&E, 10×); (b) Masson's trichrome staining highlighting septal fibrosis (arrowheads), demarcating regenerative nodules, consistent with definitive cirrhosis (Ishak score 6); (c) Presence of septal and intralobular lymphocyte-predominant inflammatory infiltrate (arrows) and focal hepatocellular necrosis (dashed circle) (H&E, 100×); (d) Multinucleated giant hepatocytes (arrows) and mild interface hepatitis (asterisk) (H&E, 200×); (e) Multinucleated giant hepatocytes (arrows), having more than 4–5 nuclei, and the aforementioned features of hepatitis, allowing the diagnosis of PIGCH. Eosinophils are also noted (arrowhead) (H&E, 400×).</p>" ] ] 1 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc1.doc" "ficheroTamanyo" => 540672 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Autoimmune post-infantile giant cell hepatitis: a case report and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Y. Xiao" 1 => "Z.H. Gao" 2 => "M. Deschenes" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3138/canlivj-2020-0024" "Revista" => array:6 [ "tituloSerie" => "Can Liver J" "fecha" => "2021" "volumen" => "4" "paginaInicial" => "104" "paginaFinal" => "109" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35991767" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Postinfantile giant cell hepatitis: an etiological and prognostic perspective" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C. Bihari" 1 => "A. Rastogi" 2 => "S.K. Sarin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1155/2013/601290" "Revista" => array:5 [ "tituloSerie" => "Hepat Res Treat" "fecha" => "2013" "volumen" => "2013" "paginaInicial" => "601290" "itemHostRev" => array:3 [ "pii" => "S1556086420311072" "estado" => "S300" "issn" => "15560864" ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Post-infantile giant cell hepatitis: a literature review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. Jiao" 1 => "X. Zhang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.14218/jctp.2022.00016" "Revista" => array:7 [ "tituloSerie" => "J Clin Transl Pathol" "fecha" => "2022" "volumen" => "2" "paginaInicial" => "100" "paginaFinal" => "107" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/37092012" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1556086421021250" "estado" => "S300" "issn" => "15560864" ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Post-infantile giant cell hepatitis: a single center's experience over 25 years" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "B. Matta" 1 => "R. Cabello" 2 => "M. Rabinovitz" 3 => "M. Minervini" 4 => "S. Malik" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4254/wjh.v11.i12.752" "Revista" => array:6 [ "tituloSerie" => "World J Hepatol" "fecha" => "2019" "volumen" => "11" "paginaInicial" => "752" "paginaFinal" => "760" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31966907" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Case report: fatal acute liver failure with giant cell transformation in a pediatric patient associated with MIS-C" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C. Bonilla Gonzalez" 1 => "M. Hincapié Echeverría" 2 => "R. Plazas Pachón" 3 => "P. Mora Umaña" 4 => "B.L. Diaz Gómez" 5 => "N. Gualdron Barreto" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3389/fped.2021.780258" "Revista" => array:5 [ "tituloSerie" => "Front Pediatr" "fecha" => "2022" "volumen" => "9" "paginaInicial" => "780258" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35127589" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000016300000002/v1_202407220832/S2387020624002894/v1_202407220832/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000016300000002/v1_202407220832/S2387020624002894/v1_202407220832/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020624002894?idApp=UINPBA00004N" ]
