전격성 B형 간염 치료중에 속발한 C형 간염

박상훈(Sang Hoon Park),박이병(Yi Beong Park),연종은(Jong Eun Yeon),김재선(Jae Seon Kim),박영태(Young Tae Bak),권소영(So Young Kwon),변관수(Kwan Soo byun),이창홍(Chang Hong Lee) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.1

Fulminant hepatitis is one of the fatalest liver diseases, but the liver injury is potential]y reversible and liver usually returns to normal in patients who recover from the disease. Recently some Japanese studies reported that serologic markers of hepatitis C virus(HCV) were found in some patients with fulminant hepatitis B, and they suggested HCV may play an important role in the development of fulminant hepatitis B. But the detection of HCV markers may mean a newly acquired HCV infection other than co-infection, because HCV infection could occur during the treatment of fulminant hepatitis B such as transfusion of blood or blood products. We report a case of fulminant hepatitis B, which progressed to chronic hepatitis. This case shows that a newly acquired HCV infection can occur in the ccurse of fulminant hepatitis B, and that HCV infection may play a role in the progression to chronic liver disease after recovery from fulminant hepatitis B. (Korean J Gastroenterol 1996;28: 124 - 130)

Original Article : Factors influencing the severity of acute viral hepatitis A

( Joo Il Kim ),( Yun Soo Kim ),( Young Kul Jung ),( Oh Sang Kwon ),( Yeon Suk Kim ),( Yang Suh Ku ),( Duck Joo Choi ),( Ju Hyun Kim ) 대한간학회 2010 Clinical and Molecular Hepatology(대한간학회지) Vol.16 No.3

Background/Aims: Most patients with acute viral hepatitis A have a favorable course, but a few of them suffer from severe forms of hepatitis such as fulminant hepatitis. This study was carried out to identify the factors influencing the severity of acute viral hepatitis A. Methods: We retrospectively reviewed the medical records of 713 patients with acute hepatitis A, who were divided into two groups: severe hepatitis A (N=87) and non-severe hepatitis A (N=626). Severe hepatitis was defined as fulminant hepatitis or prolongation of prothrombin time (INR≥1.5). Clinical variables were compared between the two groups. Results: The incidence of fulminant hepatitis was 1.4 % (10/713) in patients with acute hepatitis A. Thirty-three (4.6 %) cases exhibited HBsAg positivity. In multivariate analyses, significant alcohol intake and the presence of HBsAg were significant predictive factors of fulminant hepatitis A, and significant alcohol intake and age were significant predictive factors of severe hepatitis A. HBeAg and HBV-DNA status did not affect the clinical course of hepatitis A in chronic hepatitis B carriers. Conclusions: While most patients with acute hepatitis A have an uncomplicated clinical course, our data suggest that a more-severe clinical course is correlated with being older, significant alcohol intake, and chronic hepatitis-B-virus infection. (Korean J Hepatol 2010;16:295-300)

전격성 간염으로 발병된 Wilson 간염

박이병(Yi Beong Park),이정용(Jeong Yong Lee),연종은(Jong Eun Yeon),박상훈(Sang Hoon Park),권소영(So Young Kwon),변관수(Kwan Soo byun),박영태(Young Tae Bak),김진호(Jin Ho Kim),이창홍(Chang Hong Lee),최상용(Sang Yong Choi),원남희(Nam H 대한소화기학회 1996 대한소화기학회지 Vol.28 No.2

Wilson's disease presenting as fulminant hepatic failure is a rare and poorly recognized disorder. When Kayser-Fleischer ring is absent and liver biopsy cannot be performed, the patient may not be diagnosed and treated specifically. But it is crucial that the entity of fulminant Wilsonian hepatitis be clinically recognized because of its uniformly fatal outcome if liver transp]antation is not performed in a timely fashion. We present herein the case of a 16-year-old gir] with fulrninant Wilsonian hepatitis. She was admitted to the hospital with clinical features of fulminant hepatic failure, and showed characteristic biochemical profiles of fulminant Wilsonian hepatitis and Coombs negative hemolytic anemia. She was treated with liver transplantation successfully, and confirmed by histopathologic finding and measurement of hepatic copper concentration. We discuss the importance of fulminant Wilsonian in the differential diagnosis of fulminant hepatic failure. (Korean J Gastroenterol 1996; 28:292 - 297)

중증 급성 간염으로 발현한 혈구탐식증후군에 관한 연구

유정민,장수희,김준성,이주훈,이미정,박기영,김경모,서종진,문형남,김태형,지현숙,Ryu, Jeong Min,Chang, Soo Hee,Kim, Joon Sung,Lee, Joo Hoon,Lee, Mi Jeong,Park, Kie Young,Kim, Kyung Mo,Seo, Jong Jin,Moon, Hyung Nam,Ghim, Thad,Chi, Hyun So 대한소아소화기영양학회 2005 Pediatric gastroenterology, hepatology & nutrition Vol.8 No.2

목 적: 혈구탐식 증후군은 지속적인 고열, 간비종대, 혈구감소증, 고 페리틴혈증, 간과 비장 또는 임파절 등의 망상내피계 전반에 걸쳐 적혈구탐식을 보이는 양성 대식세포의 활성화와 증식을 특징으로 하는 질환으로, 심한 급성간염 또는 전격성 간염으로 발현할 수 있어 소아소화기분과로 처음 의뢰되는 경우가 많은데, 혈구탐식증후군은 조기에 etoposide를 포함하는 항암치료 요법을 시행한 후 필요시 골수이식을 시행함으로써 완치가 가능한 질환이나, 다른 원인의 전격성 간염의 경우에는 간이식이 필요하다는 점에서 정확한 감별이 요구된다. 방 법: 1994년 2월부터 2005년 3월까지 서울아산병원 소아과에서 혈구탐식증후군으로 진단받은 환아 23명 중 중증 급성 간염의 소견으로 발현한 11명의 의무기록을 토대로 후향적으로 인구학적 특징, 임상 양상, 검사 결과 등을 분석하였다. 결 과: 전체 혈구탐식 증후군 환아들 23명 중 중증 급성 간염 소견으로 발현한 예는 모두 11예로 48%였고, 이 중 소아소화기 분과로 처음 의뢰된 환아가 7명(64%)으로 반 이상을 차지하였다. 평균 나이는 50개월이었다. 원인으로 가족력은 없었고 바이러스 감염이 4예(36%)에서 증명되었는데, 골수에서 EBV PCR 양성이었으며, 이 중 1예는 HSV PCR이 동시에 양성이었다. 임상 증상으로는 발열이 10예(91%), 간비종대가 모든 환아(100%)에서 있었고, 황달 10예(91%), 점상출혈 3예(27%), 임파절 비대가 3예(27%), 호흡기 증상은 3예(25%)에서 관찰되었다. 혈액학적 소견으로 빈혈 91%, 혈소판 감소증 91%, 백혈구 감소증이 72%에서 관찰되었다. 고 중성지방혈증은 81%, 저 피브리노겐 혈증은 72%에서, 고 페리틴혈증은 64%에서 있었다. 총 9명의 환아가 etoposide를 포함하는 항암요법을 받았고 사망률은 11명 중 8명으로 72%였는데, 발병시부터 4주 이내에 항암요법을 시작한 경우의 사망률은 50%, 4주 이후에 시작한 경우의 사망률은 80%였다. 2세 미만의 환아의 사망률은 100%였다. 결 론: 상당수의 소아 혈구탐식증후군 환아들이 심한 급성 간염 및 간부전, 전격성 간염 등으로 발현할 수 있으며, 특히 지속적인 고열과 혈구감소증 등이 동반된 경우 혈구탐식증후군을 의심하여 조기에 진단하고 4주 이내에 etoposide를 포함한 항암요법과 필요시 골수이식을 실시하여 완치의 가능성을 추구하여야 하며, 다른 원인에 의한 전격성 간염으로 오진하여 불필요한 간이식을 시행하지 않도록 해야할 것이다. Purpose: Hemophagocytic syndrome (HPS) is characterized by persistent high fever, hepatosplenomegaly, cytopenias, hypertriglyceridemia, and/or hypofibrinogenemia. Hepatic manifestations including overt hepatic failure and fulminant hepatitis are common in HPS. Liver transplantation (LT) should be considered in a case of fulminant hepatitis by other than HPS, but LT is contraindicated and complete cure is possible by chemotherapy in HPS. Therefore, we conducted this study to define the characteristics of HPS presenting as severe acute hepatitis. Methods: Among the total of 23 patients diagnosed as HPS by bone marrow examination between 1994 and 2005 in Asan Medical Center, 11 cases presented as severe acute hepatitis were enrolled in this study. We analyzed the clinical features, laboratory findings and outcome retrospectively. Results: Seven (64%) of the 11 children with HPS and hepatitis were referred to pediatric gastroenterologist at first. The mean age of onset was 50 months. There was no case with family history of primary HPS. Epstein-Barr virus was positive in 4, and herpes Simplex virus was positive simultaneously in 1 case. As the presenting symptoms and signs, fever was present in 10, hepatosplenomagaly was noted in all and jaundice in 10. Anemia was observed in 10, thrombocytopenia in 10, leukopenia in 8, hypertriglyceridemia in 9, hypofibrinogenemia in 8 and hyperferritinemia in 7 cases, respectively. Nine children received chemotherapy including etopside. The overall mortality rate was 72% (8/11). Conclusion: HPS, which needs chemotherapy, should be considered as a cause of severe acute hepatitis especially when accompanied with prolonged high fever and cytopenias.

급성 간염 후에 발생된 재생불량빈혈 1례

이대성,이정현,박재선,김미향 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.3

Aplastic anemia following acute hepatitis with or without acute hepatic failure is an uncommon and known to have a poor prognosis. We experienced a case of aplastic anemia following acute hepatic failure in a 13 year-old boy. He had been admitted because of jaundice and lethargy for 2 weeks and clinical findings of acute fulminant hepatitis. Serum studies for antibodies and antigens related to hepatitis A, B, C viruses and cytomegalovirus, Ebstein-Barr virus, and, parvovirus B19 were negative. He had been recovered and discharged. He was readmitted because of lethargy and stuporous mentality 5 months later. Laboratory finding showed pancytopenia in peripheral blood smear and hypocellularity of all hematopoietic elements in bone marrow biopsy. Patient had been treated by s teroid and oxymetholone for a month before he died of sepsis

면역글로불린 G가 정상이며 전격성 간염으로 발현한 소아에서의 1형 자가면역성 간염 2례

홍지영,배선환,김완섭 대한소아과학회 2002 小兒科 Vol.45 No.10

Effects of Injinchunggantang(茵蔯淸肝湯) on Fulminant Mouse Viral Hepatitis

Lee,Jang-hoon,Woo,Hong-jung,Kim,Young-chul,Kim,Jin-joo WHO COLLABORATING CENTRE FOR TRADITIONAL MEDICINE 1996 東西醫學硏究所 論文集 Vol.1996 No.-

<Objectives> 10% of Korean adults are hepatitis B virus carriers, and there has been no satisfactory treatment in western medicne. So, this study was done to confirm the liver protective effects of herbal medicine, Injinchunggantang on fulminant viral hepatitis. <Methods> 680g of Injinchunggantang was decocted twice for 2 hours respectively, filtrated, vacuumevaporated and powderized by a spray dryer. 10ml/kg on Injinchunggantang was given orally for 8 consecutive days to 4 experimental groups, which consisted of 13 mice, respectively; the MHV-2 only group, the MHV-2+Injinchunggantang 1,000mg/kg group, the MHV-2+Injinchunggantang 300mg/kg group and the uninfected control group. Virus titer in hepatocyte was measured by the Hirano's method. And immunofluorescence, serological findings, histopathological findings were observed. <Results> The survivality was 20% in mice inoculated only with the MHV-2,53% in mice inoculated with the MHV-2+ Injinchunggantang (1,000mg/kg), 26% in mice inoculated with the MHV-2 + Injinchunggantang(300mg/kg). In viral growth, virus titer of the Injinchunggantang 1,000mg/kg group was somewhat lower than that of the MHV-2 only group, while there was no significant difference between the Injinchunggantang 300mg/kg group and the MHV-2 only group. In serological values(ALT, AST, ALP, LDH), there were no significant differences among the MHV-2 only group and the Injinchunggantang 1,000mg/kg and 300mg/kg groups. Hepatic lesion in the MHV-2 only group was characterized by massive hepatic necrosis without inflammatory cell infiltration. However, zonal necrosis and inflammatory cell infiltration were observed in the Injinchunggantang 1,000mg/kg group. And the Injinchungantang 300mg/kg group was characterized by massive hepatic necrosis and moderate inflammatory cell infiltration. <Conclusion> Injinchunggantang showed dose-dependent, liver protective effect on fulminant hepatitis. And clinical use of Injinchunggantang on hepatic diseases is recommendable.

Effects of Injinchunggantang(茵蔯淸肝湯)on Fulminant Mouse Viral Hepatitis

Kim,Young-chul,Kim,Jin-joo,Lee,Jang-hoon,Woo,Hong-jung INSTITUTE OF ORIENTAL MEDICINE KYUNG-HEE UNIVERSIT 1996 JOURNAL OF ORIENTAL MEDICINE Vol.1 No.1

<Objectives> 10% of Korean adults are hepatitis B virus carriers, and there has been no satisfactory treatment in western medicine. So, this study was done to confirm the liver protective effects of herbal medicine, Injinchunggantang on fulminant viral hepatitis. <Methods> 680g of Injinchunggantang was decocted twice for 2 hours respectively, filtrated, vacuum-evaporated and powderized by a spray dryer. 10ml/kg of Injinchunggantang was given orally for 8 consecutive days to 4 experimental groups, which consisted of 13 mice, respectively; the MHV-2 only group, the MHV-2+Injinchunggantang 1,000mg/kg group, the MHV-2+Injinchunggantang 300mg/kg group and the uninfected control group. Virus titer in hepatocyte was measured by the Hirano's method. And immunofluorescence, serological findings, histopathological findings were observed. <Results> The survivality was 20% in mice inoculated only with the MHV-2,53% in mice inoculated with the MHV-2+Injinchunggantang (1,000mg/kg), 26% in mice inoculated with the MHV-2+Injinchunggantang(300mg/kg). In viral growth, virus titer of the Injinchunggantang 1,000mg/kg group was somewhat lower than that of the MHV-2 only group, while there was no significant difference between the Injinchunggantang 300mg/kg group and the MHV-2 only group. In serological values (ALT, AST, ALP, LDH), there were no significant differences among the MHV-2 only group and ghe Injinchunggantang 1,000mg/kg and 300mg/kg groups. Hepatic lesion in the MHV-2 only group was characterized by massive hepatic necrosis without inflammatory cell infiltration. However, zonal necrosis and inflammatory cell infiltration were observed in the Injinchunggantang 1,000mg/kg group. And the Injinchunggantang 300mg/kg group was characterized by massive hepatic necrosis and moderate imflammatory cell infiltration. <Conclusion> Injinchunggantang showed dose-dependent, liver protective effect on fulminant hepatitis. And clinical use of Injinchunggantang on hepatic diseases is recommendable.

Acute Liver Failure due to Disseminated Varicella Zoster Virus Infection

( Hyun Jeong Lee ),( Yong Joon Kim ),( Tae Hee Lee ),( Sung Ju Kang ),( Jong Woo Kim ),( Jung Min Lee ),( Hyo In Jeon ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1

Aims: Varicella zoster virus (VZV) can cause chicken pox and herpes zoster. VZV infection can result in life-threatening complications including hepatitis, pneumonitis and encephalitis, especially in immunocompromised patients. We report a case of varicella hepatitis and esophagitis in a healthy patient with a recent use of steroids. Methods: A 54-year-old male with hypertension, presented to the emergency department with two days of abdominal pain. A week ago he was discharged from the department of ophthalmology. The following drugs were used during the hospital stay; Intravenous(IV) methylprednisolone for 4 days, oral prednisolone for 7 days, oral levofloxacin for 3 weeks, and IV flomoxef for 2 weeks. Laboratory studies showed leukocytosis and elevation of liver enzymes. We performed abdomen computerized tomography, which showed mild hepatomegaly with periportal edema. He was hospitalized for hepatitis. The morning after, we underwent upper gastrointestinal endoscopy due to sustained abdominal pain. Endoscopy showed white multiple punch-out-shaped ulceration (Figure 1). After 24 hours of hospitalization, diffuse maculopapular eruption on the whole body was noted (Figure 2). Results: Considering the clinical situation, disseminated VZV infection with secondary bacterial infection was suspected, and IV acyclovir, VZV immunoglobulin, IV ceftriaxone was initiated. In addition, IV hydrocortisone was used upon the diagnosis of adrenal insufficiency. On day 2 of hospitalization, laboratory studies showed worsening liver enzyme elevations and coagulopathy. Within 48 hours of admission, the patient expired with multi-organ failure accompanied by hepatic failure. A few days after the patient’s death, blood PCRs were positive with VZV and the biopsy showed multi-nucleated giant cells (Figures 3, 4). Liver biopsy was not performed due to the patient’s rapid deterioration. Conclusions: This case is very unusual as there were no pre-existing factors such as an underlying immunocompromised state or advanced age. We should keep in mind that recent steroid use may increase the risk of fatal varicella.

급성 용혈성 빈혈과 전격성 간염 양상으로 증상발현을 보인 Wilson씨 병 1례

김진영,나경선,김성훈,김인순 大韓血液學會 2000 大韓血液學會誌 Vol.35 No.2