A case of syncytial giant cell hepatitis with features of a paramyxoviral infection
A case of syncytial giant cell hepatitis with features of a paramyxoviral infection
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DOI：
10.1111/j.1572-0241.1998.00548.x
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发表时间：
1998-10-01
影响因子：
9.8
通讯作者：
Mason, AL
中科院分区：
文献类型：
--
作者：
Fimmel, CJ;Guo, LS;Mason, AL
成人合胞体巨细胞肝炎 (GCH) 是一种罕见且通常为暴发性的肝炎，可能由新型副粘液样病毒感染引起。我们介绍一名 69 岁男性的病例，他患有急性社区获得性肝炎和慢性淋巴细胞白血病。肝活检显示全小叶合胞体巨细胞肝炎的典型表现。电子显微镜检查显示受影响肝细胞的细胞质和细胞核中有丰富的核衣壳样蛋白质物质。这些结构与已知的副粘病毒科相似但不同，表明感染了一种新型相关病毒。使用针对麻疹融合蛋白基因的探针进行的原位杂交研究给出了肝细胞分布的阳性信号。麻疹核衣壳蛋白探针没有获得信号，这表明该疾病病原体在遗传上与麻疹病毒不同，但与之相关。随后的肝活检的特点是巨细胞变化逐渐消失，并伴随发生肝硬化。这是一例成人 GCH 自发消退并导致肝硬化的病例，因此表明 GCH 是“隐源性”肝病的潜在原因。我们的研究结果进一步支持了一种独特的、尚未确定的病毒种类是导致这种疾病的原因。 （Am J Gastroenterol 1998；93：1931-1937。(C) 1998，Am. Cell. of Gastroenterology）。
Adult syncytial giant cell hepatitis (GCH) is an uncommon and often fulminant form of hepatitis that may be caused by infection with a novel paramyxo-like virus. We present the case of a 69-yr-old man who presented with acute, community-acquired hepatitis and chronic lymphocytic leukemia. A liver biopsy showed the typical findings of panlobular syncytial giant cell hepatitis. Electron microscopic examination demonstrated abundant nucleocapsid-like protein material in the cytoplasm and nuclei of affected hepatocytes, These structures were similar to, but distinct from, those of known paramyxoviridae, suggesting infection with a novel, related virus. In situ hybridization studies with a probe directed against the measles fusion protein gene gave a positive signal with a hepatocyte distribution. No signal was obtained with the measles nucleocapsid protein probe, suggesting that the disease agent was genetically distinct from, but related to, the measles virus. Subsequent liver biopsies were characterized by the gradual disappearance of the giant cell changes and by the concomitant development of cirrhosis, This is a case of adult GCH that resolved spontaneously and led to cirrhosis, thus implicating GCH as a potential cause of "cryptogenic" liver disease. Our findings provide further support for the existence of a distinct, as yet unidentified viral species as a cause of this disease. (Am J Gastroenterol 1998; 93:1931-1937. (C) 1998 by Am. Cell. of Gastroenterology).