Hepatocellular disease in the giant-cell arteritis/polymyalgia rheumatica syndrome.

Abstract

SUMMARY An elderly man developed temporal arteritis and polymyalgia rheumatica with coexisting biochemical abnormalities of liver function. Biopsy revealed hepatic changes which have not been previously reported. There was hepatocellular necrosis and inflammation together with a prominent hyperplasia of perisinusoidal lipocytes of Ito. Temporal artery biopsy confirmed the presence of granulomatous panarteritis. Corticosteroid therapy produced rapid resolution of symptoms and reversion of liver function tests to normal.The association of giant cell (temporal) arteritis with polymyalgia rheumatica is well recognised.'Most workers now accept polymyalgia rheumatica as a clinical manifestation of giant cell arteritis,2 3 and temporal arteritis has also been observed following treatment of polymyalgia rheumatica.Little is known about the systemic effects of giant cell arteritis. Lesions of the myocardium, kidneys, gastrointestinal tract, and nervous system have been attributed to underlying arteritis.5 Changes in liver function tests have frequently been documented. These changes have been variable, with elevation of alkaline phosphatase being the most frequent abnormality.6 7 The histology of liver biopsies from these patients has mainly been normal.2 In some instances nonspecific fatty change was found,8 and single granulomas were described in 2 cases.7 9 We report a case of giant cell arteritis with hepatocellular necrosis and hyperplasia of perisinusoidal lipocytes of Ito, histological changes which hitherto have not been described in this syndrome. Case reportA 64-year-old man presented with a 3-month history of right-sided intermittent facial pain. His headache and facial pain became continuous and were asso-

Abnormal Liver Function Test in a Patient with Polymyalgia Rheumatica

“…Serum alkaline phosphatase appears to be the most consistently elevated enzyme in 18 to 62% of patients with polymyalgia rheumatic 4,5 . Elevated alanine and aspartate transaminases occur in 18% of patients with polymyalgia rheumatica 5 .…”

“…Imaging of the liver may sometimes reveal granulomas or cavernous hemangiomas 6,7 . The pathogenesis of elevated transaminases in polymyalgia rheumatica remains unclear, but is postulated to be related to the deposition of circulating immune complexes in the branches of hepatic artery 4 . Other laboratory abnormalities in polymyalgia rheumatica include anaemia, leukocytosis and elevated inflammatory markers 1,8 .…”

“…Elevated alanine and aspartate transaminases occur in 18% of patients with polymyalgia rheumatica 5 . Serum bilirubin is typically normal 4 . Histology of liver biopsy is usually normal, although hepatocytes necrosis with accompanying portal and lobular inflammation has been reported 4 .…”

“…Serum bilirubin is typically normal 4 . Histology of liver biopsy is usually normal, although hepatocytes necrosis with accompanying portal and lobular inflammation has been reported 4 . Imaging of the liver may sometimes reveal granulomas or cavernous hemangiomas 6,7 .…”

Fevers, headache and abnormal liver function in a 68-year-old man

“…Histological findings encountered under light microscopy have included normal liver, non-specific steatosis, cholestasis, hepatocellular necrosis, portal tract inflammation, and perisinusoidal lipocyte hyperplasia. 4 Electron microscopy has demonstrated ultrastructural damage to bile canaliculi in a solitary case report. 5 Overt hepatic giant cell arteritis 6,7 or granulomatous inflammation of the liver 8 in patients with clinical and/or temporal artery biopsy-proven GCA/PMR is exceedingly rare.…”