Prolonged cholestasis triggered by hepatitis A virus infection and variants of the hepatocanalicular phospholipid and bile salt transporters
Hepatitis A virus (HAV) infection resolves in most patients uneventfully within weeks from the onset of the disease. In rare cases, however, it may relapse or cause prolonged cholestasis. Here we present a case of a 36-year-old female patient who developed severe pruritus and jaundice three weeks af...
Main Authors: | , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
Elsevier
2012-09-01
|
Series: | Annals of Hepatology |
Subjects: | |
Online Access: | http://www.sciencedirect.com/science/article/pii/S1665268119314486 |
id |
doaj-aec40f86069e4d17ab781e81edfdbf60 |
---|---|
record_format |
Article |
spelling |
doaj-aec40f86069e4d17ab781e81edfdbf602021-06-09T05:54:41ZengElsevierAnnals of Hepatology1665-26812012-09-01115710714Prolonged cholestasis triggered by hepatitis A virus infection and variants of the hepatocanalicular phospholipid and bile salt transportersMarcin Krawczyk0Frank Grünhage1Miriam Langhirt2Rainer M. Bohle3Frank Lammert4Department of Medicine II, Saarland University Medical Center, Homburg, GermanyCorrespondence and reprint request:; Department of Medicine II, Saarland University Medical Center, Homburg, GermanyDepartment of Medicine II, Saarland University Medical Center, Homburg, GermanyInstitute of Pathology, Saarland University Medical Center, Homburg, GermanyDepartment of Medicine II, Saarland University Medical Center, Homburg, GermanyHepatitis A virus (HAV) infection resolves in most patients uneventfully within weeks from the onset of the disease. In rare cases, however, it may relapse or cause prolonged cholestasis. Here we present a case of a 36-year-old female patient who developed severe pruritus and jaundice three weeks after initially uncomplicated hepatitis A. A relapse of the infection was excluded. Since therapy with colestyramin, antihistaminics, naloxon and ursodeoxycholic acid (UDCA) did not improve symptoms, we decided to perform plasma absorption and to start rifampicin therapy. Under these measures, pruritus and jaundice, as well as serum bilirubin levels improved gradually and after four plasmapheresis sessions we were able to discharge the patient. Genetic testing showed the presence of two procholestatic polymorphisms, the c.3084 [GG] variant within the gene encoding the hepatocanalicular bile salt transporter ABCB11 and the c.711 [AT] variant of the phosphatidylcholine floppase ABCB4. We speculate that this compound ABCB4-ABCB11 genotype led to a severe intrahepatic cholestasis in the setting of HAV infection. In conclusion, our case suggests that polymorphisms within the hepatocanalicular transporters may contribute to a more pronounced course of HAV infection. Although dedicated studies in large cohorts of patients are needed to confirm this observation, we speculate that patients carrying procholestatic hepatobiliary transporter variants may benefit from vaccination against hepatitis A.http://www.sciencedirect.com/science/article/pii/S1665268119314486Acute hepatitisBileCholestasisPlasmapheresis |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Marcin Krawczyk Frank Grünhage Miriam Langhirt Rainer M. Bohle Frank Lammert |
spellingShingle |
Marcin Krawczyk Frank Grünhage Miriam Langhirt Rainer M. Bohle Frank Lammert Prolonged cholestasis triggered by hepatitis A virus infection and variants of the hepatocanalicular phospholipid and bile salt transporters Annals of Hepatology Acute hepatitis Bile Cholestasis Plasmapheresis |
author_facet |
Marcin Krawczyk Frank Grünhage Miriam Langhirt Rainer M. Bohle Frank Lammert |
author_sort |
Marcin Krawczyk |
title |
Prolonged cholestasis triggered by hepatitis A virus infection and variants of the hepatocanalicular phospholipid and bile salt transporters |
title_short |
Prolonged cholestasis triggered by hepatitis A virus infection and variants of the hepatocanalicular phospholipid and bile salt transporters |
title_full |
Prolonged cholestasis triggered by hepatitis A virus infection and variants of the hepatocanalicular phospholipid and bile salt transporters |
title_fullStr |
Prolonged cholestasis triggered by hepatitis A virus infection and variants of the hepatocanalicular phospholipid and bile salt transporters |
title_full_unstemmed |
Prolonged cholestasis triggered by hepatitis A virus infection and variants of the hepatocanalicular phospholipid and bile salt transporters |
title_sort |
prolonged cholestasis triggered by hepatitis a virus infection and variants of the hepatocanalicular phospholipid and bile salt transporters |
publisher |
Elsevier |
series |
Annals of Hepatology |
issn |
1665-2681 |
publishDate |
2012-09-01 |
description |
Hepatitis A virus (HAV) infection resolves in most patients uneventfully within weeks from the onset of the disease. In rare cases, however, it may relapse or cause prolonged cholestasis. Here we present a case of a 36-year-old female patient who developed severe pruritus and jaundice three weeks after initially uncomplicated hepatitis A. A relapse of the infection was excluded. Since therapy with colestyramin, antihistaminics, naloxon and ursodeoxycholic acid (UDCA) did not improve symptoms, we decided to perform plasma absorption and to start rifampicin therapy. Under these measures, pruritus and jaundice, as well as serum bilirubin levels improved gradually and after four plasmapheresis sessions we were able to discharge the patient. Genetic testing showed the presence of two procholestatic polymorphisms, the c.3084 [GG] variant within the gene encoding the hepatocanalicular bile salt transporter ABCB11 and the c.711 [AT] variant of the phosphatidylcholine floppase ABCB4. We speculate that this compound ABCB4-ABCB11 genotype led to a severe intrahepatic cholestasis in the setting of HAV infection. In conclusion, our case suggests that polymorphisms within the hepatocanalicular transporters may contribute to a more pronounced course of HAV infection. Although dedicated studies in large cohorts of patients are needed to confirm this observation, we speculate that patients carrying procholestatic hepatobiliary transporter variants may benefit from vaccination against hepatitis A. |
topic |
Acute hepatitis Bile Cholestasis Plasmapheresis |
url |
http://www.sciencedirect.com/science/article/pii/S1665268119314486 |
work_keys_str_mv |
AT marcinkrawczyk prolongedcholestasistriggeredbyhepatitisavirusinfectionandvariantsofthehepatocanalicularphospholipidandbilesalttransporters AT frankgrunhage prolongedcholestasistriggeredbyhepatitisavirusinfectionandvariantsofthehepatocanalicularphospholipidandbilesalttransporters AT miriamlanghirt prolongedcholestasistriggeredbyhepatitisavirusinfectionandvariantsofthehepatocanalicularphospholipidandbilesalttransporters AT rainermbohle prolongedcholestasistriggeredbyhepatitisavirusinfectionandvariantsofthehepatocanalicularphospholipidandbilesalttransporters AT franklammert prolongedcholestasistriggeredbyhepatitisavirusinfectionandvariantsofthehepatocanalicularphospholipidandbilesalttransporters |
_version_ |
1721388755408912384 |