Syncytial giant cell hepatitis in a patient with chronic lymphocytic leukemia

Abstract

While it commonly occurs in the pediatric population, syncytial giant cell hepatitis is rare in adults, which is diagnosed histologically by the presence of multinucleated cells in the liver. The literature has recorded only approximately one hundred cases in adults during the past two decades in whom malignancy is rarely associated with giant cell hepatitis. Our patient is a 66-year-old woman who was diagnosed with chronic lymphocytic leukemia (CLL) and subsequently developed syncytial giant cell hepatitis. This disease is usually linked to virus infection, autoimmune diseases, and drug medications. The association between CLL and giant cell hepatitis is rare, with only three cases reported. In most cases viral particles on electron microscopy are reported and the patients usually have a history of chemotherapy and hypogammaglobulinemia. Unlike such cases, our patient developed giant cell hepatitis in the absence of such confounding variables. The treatment for our patient was a high-dose corticosteroid and rituxan, with improvement in liver enzymes.

Management of giant cell hepatitis associated with chronic lymphocytic leukemia – a case series and review of the literature

“…11 The most recent case reported by Gupta et al, GCH was diagnosed in a patient with CLL who had started allopurinol for a rising leukocytosis. 12 She was initially treated with prednisone with improvement in her transaminases and bilirubin but had a recurrence of transaminitis several months later during prednisone taper. Repeat biopsy demonstrated GCH and CLL.…”

“…1,2,[4][5][6][7][8] Recently, there have been four individual case reports of GCH associated with chronic lymphocytic leukemia. [9][10][11][12] Here, we describe three cases of GCH attributed to CLL treated at a single institution to attain oncologic and hepatic disease control.…”

Postinfantile Giant Cell Hepatitis with Features of Acute Severe Autoimmune Hepatitis Probably Triggered by Diclofenac in a Patient with Primary Myelofibrosis

“…In addition, many drugs such as methotrexate, 6-mercaptopurine, chlorpromazine, amoxicillin/clavulanate, doxycycline, NSAIDs, and herbal medicines have been reported as potential triggering factors for PIGCH development [ 2 , 26 – 28 ]. Other conditions that have been implicated in the onset of PIGCH include autoimmune and/or immune mediated disorders such as systemic lupus erythematosus, autoimmune haemolytic anaemia, ulcerative colitis, and autoimmune cholestatic diseases, namely, primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC), as well as haematological malignancies [ 2 , 18 , 29 – 35 ]. However, AIH is by far the most frequent disease associated with this rare histological entity in adults, actually accounting for almost 40% of all autoimmune related case series having features of AIH as in our case, one of few well-supported PIGCH cases [ 2 , 8 , 18 , 23 , 36 – 39 ].…”

Erfolgreiche Therapie einer idiopathischen postinfantilen Riesenzellhepatitis mit einem Calcineurininhibitor

“…Hierunter Antibiotika wie Amoxicillin und Doxycyclin, Zytostatika und Immunmodulatoren wie Methotrexat oder auch nichtsteroidale Antirheumatika [1,6,7]. Auch im Zusammenhang mit malignen und hämatologischen Erkrankungen existieren Fallberichte über PIGCH, beispielsweise bei Non-Hodgkin-Lymphomen wie der chronisch lymphatischen Leukämie (CLL) [2,8].…”

“…Bei ansteigenden Leberwerten und Nachweis CD20-positiver B-Zellen in der initialen Leberbiopsie wurde ein Therapieversuch mit Rituximab unternommen. Der Einsatz dieses monoklonalen anti-CD-20-Antikörpers zeigte in einigen Fallserien ein gutes Ansprechen und verhinderte eine Transplantation, wobei sich die Erfahrungen bisher mehrheitlich auf die infantile Riesenzellhepatitis oder CLL-assoziierte PIGCH beschränken [8,12]. Nach Rituximab und Nachschaltung einer Glukokortikoid-Therapie stellte sich bei unserem Patienten ein gutes, aber nur kurzfristiges Therapieansprechen ein.…”