Hepatitis with fibrin-ring granulomas.

Abstract

We describe a 66-year-old woman hospitalized with fever, fatigue and hepatopathy. In her medical history arterial hypertension (treated with propranolol and lisinopril), diabetes mellitus type 2 (no treatment before admission) and a gout arthropathy were noted wherefore a therapy with allopurinol 300 mg per day has been started 4 months before. Liver biopsy revealed fibrin-ring granulomas, compatible with allopurinol-induced hepatitis. Because of persistence of high fever after stopping allopurinol, steroids (1 mg/kg) were started. Under this treatment, she developed pancytopenia and fever. The bone marrow aspiration revealed Leishmania infantum. A second liver biopsy showed amastigotes and a disappearance of the granulomas. The history revealed a travel to Malta 2 years earlier. Despite adequate treatment with liposomal amphotericin B the patient deteriorated and finally died in septic shock.

• Authors: B Khanlari, M Bodmer, L Terracciano, M H Heim, U Fluckiger, M Weisser
• Journal: Infection (Infection) Vol. 36 Issue 4 Pg. 381-3 (Aug 2008) ISSN: 0300-8126 [Print] Germany
• PMID: 17926000 (Publication Type: Case Reports, Journal Article)

Chemical References

• Gout Suppressants
• Allopurinol
• Fibrin

Topics

• Aged
• Allopurinol (adverse effects)
• Animals
• Biopsy
• Bone Marrow (parasitology)
• Chemical and Drug Induced Liver Injury (complications, pathology)
• Fatal Outcome
• Female
• Fibrin (metabolism)
• Gout Suppressants (adverse effects)
• Granuloma (chemically induced, complications, pathology)
• Humans
• Leishmania infantum (isolation & purification)
• Leishmaniasis, Visceral (complications, diagnosis)
• Liver (parasitology, pathology, surgery)