scholarly journals Acute Liver Failure and Fever of Unknown Origin

2021 ◽  
Author(s):  
Terry A Marryshow ◽  
Daniel P McQuillen ◽  
Kenneth M Wener ◽  
J Morgan Freiman
Keyword(s):  
Infectious Disease ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Immune Reconstitution ◽  
Fever Of Unknown Origin ◽  
Unknown Origin ◽  
History Taking ◽  
Immune Reconstitution Syndrome ◽  
Disseminated Histoplasmosis ◽  
Infectious Disease Service

Abstract We describe a case of acute liver failure in a woman in whom a diagnosis was initially unable to be established. The patient rapidly deteriorated, requiring admission to the intensive care unit and was placed under consideration for liver transplantation. On consultation with the infectious disease service, thorough history taking was performed which uncovered salient epidemiologic information pointing toward the eventual diagnosis of disseminated histoplasmosis. We discuss aspects of diagnosis and management, including the management of immune reconstitution syndrome which complicated treatment.

scholarly journals Hemophagocytic lymphohistiocytosis (HLH) presenting as fever of unknown origin and acute liver failure

IDCases ◽  
2018 ◽  
Vol 14 ◽  
pp. e00413 ◽  
Author(s):  
Forat Lutfi ◽  
Arpan Patel ◽  
Dawn Becker ◽  
Mohammad Shahid ◽  
Kairav Shah
Keyword(s):  
Liver Failure ◽  
Acute Liver Failure ◽  
Hemophagocytic Lymphohistiocytosis ◽  
Fever Of Unknown Origin ◽  
Unknown Origin

scholarly journals HMGB1, anti-HMGB1 antibodies, and ratio of HMGB1/anti-HMGB1 antibodies as diagnosis indicator in fever of unknown origin

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Mingkun Chen ◽  
Li Zhu ◽  
Miao Xue ◽  
Rongrong Zhu ◽  
Liling Jing ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Autoimmune Disease ◽  
Serum Concentration ◽  
Malignant Tumor ◽  
Fever Of Unknown Origin ◽  
Unknown Origin ◽  
Healthy Control Group ◽  
Control Group ◽  
Elisa Kit ◽  
Healthy Control

AbstractTo evaluate the feasibility of serum HMGB1, anti-HMGB1 antibodies, and HMGB1/anti-HMGB1 ratio as a diagnosis indicator of initial clinical classification in patients with fever of unknown origin (FUO). Ninety-four patients with classical FUO and ninety healthy controls were enrolled in this study. The subjects’ clinical data and serum were collected. The serum concentration of HMGB1 was detected by a commercial HMGB1 ELISA kit, while the serum concentration of anti-HMGB1 antibodies were detected by an in-house built anti-HMGB1 antibodies ELISA kit and further confirmed by immunoblotting. According to the hospital diagnosis on discharge, ninety-four FUO patients were divided into four groups, Infectious disease subgroup, autoimmune disease subgroup, malignant tumor subgroup, and undetermined subgroup. The concentrations of HMGB1 in the infectious disease subgroup and autoimmune disease subgroup were higher than those in the malignant tumor subgroup, undetermined subgroup, and healthy control group. The concentration of anti-HMGB1 antibodies in autoimmune disease subtype group was higher than those in other subgroups as well as healthy control group. According to the distribution of HMGB1 and anti-HMGB1 in scatter plots of the patients with FUO, we found that the ratio of serum HMGB1/anti-HMGB1 is an ideal clinical indicator for differential diagnosis of different subtypes of FUO. The best cut-off was 0.75, and the sensitivity, specificity, and AUC were 66.67%, 87.32%, and 0.8, respectively. Correlation analysis showed that serum concentration of HMGB1 was moderately correlated with CRP in infectious diseases subgroup, and the serum concentration of anti-HMGB1 antibodies was strongly correlated with erythrocyte sedimentation rate in autoimmune disease subgroup. Our study had showed that serum HMGB1/anti-HMGB1 antibodies ratio can help clinicians identify FUO subtypes, thereby avoiding many unnecessary examinations and tests, and improving the effectiveness of clinical diagnosis and treatment of FUO.

Role of Autoimmunity in Patients Transplanted for Acute Liver Failure of Unknown Origin: A Clinical and Graft Biopsy Analysis

2020 ◽  
Author(s):  
Keiichi Fujiwara ◽  
Shin Yasui ◽  
Takayuki Kondo ◽  
Osamu Yokosuka ◽  
Naoya Kato
Keyword(s):  
Liver Failure ◽  
Acute Liver Failure ◽  
Unknown Origin

scholarly journals Etiology and Outcome of Acute Liver Failure: Experience from a Liver Transplantation Centre in Montreal

2002 ◽  
Vol 16 (10) ◽  
pp. 672-676 ◽  
Author(s):  
Geneviève Tessier ◽  
Edith Villeneuve ◽  
Jean-Pierre Villeneuve
Keyword(s):  
Liver Transplantation ◽  
Liver Injury ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Rapid Development ◽  
Significant Proportion ◽  
Rare Condition ◽  
Unknown Origin ◽  
The United States ◽  
Drug Induced

BACKGROUND: Acute liver failure is a rare condition in which massive liver injury is associated with the rapid development of hepatic encephalopathy. Although viral hepatitis and drug-induced liver injury are the most common causes, no specific etiology is found in a substantial proportion of cases reported from Europe and the United States.AIM: To determine the etiology and outcome of patients with acute liver failure in the authors’ institution.PATIENTS AND METHODS: The charts of 81 consecutive patients admitted to Saint-Luc between 1991 and 1999 were reviewed.RESULTS: The etiology was viral in 27 cases (33.2%), toxic or drug-induced in 22 (27.2%), of unknown origin in 22 (27.2%) and due to various causes in 10 (12.3%) (autoimmune, vascular, cancer). Of the 81 patients, 16% survived without liver transplantation, and 84% died or underwent liver transplantation. Survival without liver transplantation differed according to the mode of presentation: the survival rate was 27% in patients with hyperacute liver failure, 7% in those with acute liver failure and 0% in those with subacute liver failure. Among the 38 patients who underwent liver transplantation, survival one year after transplantation was 71%. In the 30 patients who died without liver transplantation, the main causes of death were cerebral edema and sepsis.CONCLUSIONS: Acute liver failure is associated with a high mortality, and liver transplantation is the treatment of choice. In a significant proportion of cases, the etiology remains undetermined and is probably related to yet unidentified hepatotropic viruses.

scholarly journals Subacute liver failure of unknown origin

2018 ◽  
Vol 146 (3-4) ◽  
pp. 200-202
Author(s):  
Dragan Delic ◽  
Nikola Mitrovic ◽  
Aleksandar Urosevic ◽  
Jasmina Simonovic ◽  
Ksenija Bojovic
Keyword(s):  
Liver Cirrhosis ◽  
Hepatic Encephalopathy ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Unknown Origin ◽  
Signs And Symptoms ◽  
Clinical Syndrome ◽  
Decompensated Liver Cirrhosis ◽  
Synthetic Function ◽  
Severe Liver Dysfunction

Introduction. Acute liver failure is rare and very complex clinical syndrome, the consequences of the sudden and severe liver dysfunction. There are several causes of this condition (viruses, medications, toxins, metabolic, autoimmune and malignant diseases), but etiological agent often remains undiscovered. Case Outline. A 40-year-old male patient got ill suddenly with signs and symptoms relevant for acute hepatitis, which was confirmed with biochemical analysis. The cause of acute liver failure was not determined. Despite all therapeutic measures, clinical course of the disease was bad: severe icterus, decreased synthetic function of the liver and hepatic encephalopathy developed. In the later, subacute course of the disease, developed ascites, episodes of hepatic encephalopathy and biochemical findings of chronic hepatocellular failure. After three months treatment, in hepatic coma, there was lethal outcome. Histopathological findings confirmed the diagnosis of decompensated liver cirrhosis of unknown origin. Conclusion. The cause of acute liver failure often remains unclear; potential causes should be looked for in infections with unknown viruses or in toxins exposure. The disease is most commonly presented as subacute failure with the development of liver cirrhosis. Survival rate is low.

Disseminated Histoplasmosis: A Rare Cause of Acute Liver Failure

2017 ◽  
Vol 112 ◽  
pp. S1204-S1205
Author(s):  
Edward Villa ◽  
Amit Patel ◽  
Bashar M. Attar ◽  
Melchor Demetria ◽  
Benjamin Go ◽  
...  
Keyword(s):  
Liver Failure ◽  
Acute Liver Failure ◽  
Disseminated Histoplasmosis

scholarly journals Prevalence of Connective Tissue Diseases in Egyptian Patients Presenting with Fever of Unknown Origin

2011 ◽  
Vol 4 ◽  
pp. CMAMD.S6763 ◽  
Author(s):  
Mohamad S. Abdelbaky ◽  
Howaida E. Mansour ◽  
Shafika I. Ibrahim ◽  
Iman A. Hassan
Keyword(s):  
Connective Tissue ◽  
Fever Of Unknown Origin ◽  
Urine Analysis ◽  
Complete Blood Count ◽  
Connective Tissue Diseases ◽  
Unknown Origin ◽  
Medical Problem ◽  
Advanced Technology ◽  
Diagnostic Tools ◽  
History Taking

Objective To estimate the prevalence of connective tissue diseases in patients presenting with fever of unknown origin (FUO). Patients and Methods In this study thirty patients diagnosed as FUO (Group 1), in 2008, were included in an observational study and diagnostic workup. Additionally, retrospective analysis of seventy patients’ files (Group 2), for patients who presented with prolonged unexplained pyrexia to the same hospital in the previous two years, was performed. Patients were subjected to: full clinical assessment including full history taking, thorough clinical examination, laboratory investigations including the basic investigations for patients with prolonged fever, complete blood count, erythrocytes sedimentation rate, urine analysis and culture, blood culture, sputum culture and plain chest X ray. Further diagnostic work up and/or procedures were requested according to the potential diagnostic clues (PDC) present in every patient. Results Out of 100 FUO patients, 50% were found to have infectious diseases, 24% were found to have connective tissue diseases, 8% miscellaneous causes and 7% neoplastic diseases ( P < 0.05). In 11 patients no definite cause for FUO could be identified. Connective tissue patients were: eight systemic lupus patients (33.3%), five patients with familial mediterranean fever (20.8%), four patients with rheumatoid arthritis (16.6%), three patients (12.5%) with Still's disease and Rheumatic fever and one patient with Behçet syndrome/Crohn's disease (4.3%), ( P < 0.05). Conclusions Despite the advanced technology, FUO remains a challenging medical problem. Infections were the most common cause of FUO in Egypt, confirming the trends found in other parts of the world. There was an increased prevalence of connective tissue patients presented with prolonged unexplained fever. A keen clinical eye, meticulous history taking and repeated physical examination remained the most important diagnostic tools in FUO patients.

scholarly journals Diagnostic Use of Serum Ferritin Levels to Differentiate Infectious and Noninfectious Diseases in Patients with Fever of Unknown Origin

2013 ◽  
Vol 34 (3) ◽  
pp. 211-218 ◽  
Author(s):  
Seong Eun Kim ◽  
Uh Jin Kim ◽  
Mi Ok Jang ◽  
Seung Ji Kang ◽  
Hee Chang Jang ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Infectious Diseases ◽  
Serum Ferritin ◽  
Fever Of Unknown Origin ◽  
Inflammatory Diseases ◽  
Unknown Origin ◽  
University Hospital ◽  
Disease Group ◽  
Hematologic Disease ◽  
Hematologic Diseases

INTRODUCTION: In this study, we determined whether serum ferritin levels could be used to differentiate between fever of unknown origin (FUO) caused by infectious and noninfectious diseases.METHODS: FUO patients were hospitalized at Chonnam National University Hospital between January, 2005 and December, 2011. According to the final diagnoses, five causes were identified, including infectious diseases, hematologic diseases, noninfectious inflammatory diseases, miscellaneous and undiagnosed.RESULTS: Of the 77 patients, 11 were caused by infectious diseases, 13 by hematologic diseases, 20 by noninfectious inflammatory diseases, 8 by miscellaneous diseases, and 25 were undiagnosed. The median serum ferritin levels in infectious diseases was lower than those in hematologic diseases and (median (interquartile range) of 282.4 (149.0–951.8) ng/mL for the infectious disease group, 1818.2 (485.4–4789.5) ng/mL for the hematologic disease group, and 563.7 (399.6–1927.2) ng/mL for the noninfectious inflammatory disease group,p= 0.048, Kruskal–Wallis test). By comparison using the Mann–Whitney test, statistically significant differences were found only between the infectious disease and hematologic disease groups (p= 0.049) and between the infectious disease and groups (p= 0.04).CONCLUSION: An optimal cutoff value of serum ferritin levels to predict FUO caused by a noninfectious disease (hematologic diseases, noninfectious inflammatory diseases) was established as 561 ng/mL.

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