Enlargement of perihepatic lymph nodes in relation to liver histology and viremia in patients with chronic hepatitis C

Abstract

Hepatitis C virus (HCV) infection is one of the most comInflammatory processes in organs frequently lead to hypermon causes of chronic hepatitis and cirrhosis. 1,2 HCV is an plasia of regional lymph nodes. In the present study, we inves-RNA virus that preferentially replicates in hepatocytes; howtigated whether lymph node enlargement within the hepatoever, mononuclear lymphocytes may serve as a possible exduodenal ligament may reflect the inflammatory activity trahepatic site for HCV replication.3-5 Kinetic analysis of virus within the liver of patients chronically infected with the hepaturnover revealed that HCV replicates continuously and is titis C virus (HCV). In 114 patients with chronic hepatitis C highly productive in vivo. In chronically infected patients, and 49 healthy controls, the total lymph node volume within approximately 10 10 hepatitis C virions are produced and subthe hepatoduodenal ligament was prospectively investigated sequently degraded by antigen-specific and nonspecific proby ultrasound. In patients with chronic hepatitis C, a liver cesses every day. 6biopsy was taken at the same occasion, and specimens were Inflammatory processes in organs frequently lead to hypersemiquantitatively evaluated by the histological activity index plasia of regional lymph nodes. Lymph node enlargement (HAI). Hepatitis C viremia was assessed by quantitative rewithin the hepatoduodenal ligament may be present in paverse transcription-polymerase chain reaction (RT-PCR). Getients with acute or chronic liver disease, and could reflect notyping was performed by a reverse hybridization assay. In the inflammatory activity and/or the immunological response 104 of 114 patients (91.2%) and in 45 of 49 healthy controls of the host. Lymph nodes in the hepatoduodenal ligament (91.8%), adequate visualization of the region of the hepatoducan noninvasively be detected using modern imaging techodenal ligament was achieved by ultrasound. Lymph nodes niques such as ultrasound. 7-15were detected in all patients with chronic hepatitis C and in In the present study, we investigated the size of lymph 33 of 45 controls. The mean perihepatic lymph node volume nodes within the hepatoduodenal ligament in patients with in healthy controls (2.2 { 1.8 mL) was lower than in HCVchronic hepatitis C and healthy controls. The lymph node infected patients with mild to moderate inflammatory activity, status in the hepatoduodenal ligament was correlated with severe inflammatory activity, and patients with cirrhosis liver histology, HCV genotype, hepatitis C viremia, and liver (5.8 { 2.2 mL, 18.1 { 10.4 mL, and 22.8 { 18.8 mL, respecfunction tests. tively). In patients with HCV-RNA levels of less than 10 6 copies/mL, the total lymph node volume was 5.8 { 1.6 mL PATIENTS AND METHODS and was significantly increased in patients with higher viremia (20.3 { 13.8 mL; P õ 10 06 ). No correlation was found bePatients and Controls. Between February 1995 and May 1996, 114 tween the total lymph node volume within the hepatoduodeconsecutive patients with ch...

Intrahepatic B‐cell follicles of chronically hepatitis C virus‐infected individuals lack signs of an ectopic germinal center reaction

“…It might be that other factors required to create the appropriate milieu for a GC reaction are usually missing in the liver microenvironment. A potential compartment where HCV can activate B cells might be perihepatic lymph nodes, which are frequently enlarged in patients with chronic HCV infection, and this is directly related to viral replication and to the recruitment of inflammatory cells [28,[43][44][45].Although we did not find indication for affinity maturation and hence antigen selection in the B-cell follicles, the IgV H gene segment usage indicated that antigen-specific B cells are preferentially recruited into these structures. In all seven follicles analysed, there was a preferential usage of the VH1-69 segment among the cloned V H 1 family rearrangements.…”

Functional B-cell response in intrahepatic lymphoid follicles in chronic hepatitis C

“…On the other hand, upper abdominal lymph nodes are often enlarged in chronically HCV-infected patients, particularly in patients with viremia, suggesting that an HCV-specific immune response occurs in the regional lymph nodes in those patients 19,20 as well as in patients with other types of acute and chronic hepatitis. 21 In most infectious diseases, activation, differentiation, and proliferation of B cells specific for certain antigens usually occur in the lymph follicles of secondary lymphoid organs such as the regional lymph nodes and the spleen.…”

Significant Liver Injury with Dual Positive IgM Antibody to Epstein-Barr Virus and Cytomegalovirus as a Puzzling Initial Manifestation of Infectious Mononucleosis

“…intraabdominal, lymphadenopathy in IM (9). In the case of viral or immune-mediated liver disease, enlargement of perihepatic (9,16), peripancreatic (17) or retroperitoneal (18) lymph nodes represents activity of regional inflammation and/or immune response of the host, such as viral replication within the liver, direct spread of the hepatic inflammatory process, or recruitment of infected lymphocytes and/or macrophages to draining lymph nodes (16,18). In the case of EBV infection, proliferation of lymphocytes and/or production of immunoglobulin may be added to the definition of lymphadenopathy because of the lymphotropic nature of EBV and its potent B-cell stimulating action (3).…”