scholarly journals Acute Hepatitis E: A Rare Cause of Acute Liver Failure in a Patient With Acute Myeloid Leukemia

Cureus ◽  
2020 ◽  
Author(s):  
Zachary Field ◽  
Michelle Russin ◽  
Rodrigo M Murillo Alvarez ◽  
Mario Madruga ◽  
Steve Carlan
Keyword(s):  
Acute Myeloid Leukemia ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Acute Hepatitis ◽  
Myeloid Leukemia ◽  
Hepatitis E ◽  
Acute Hepatitis E ◽  
Acute Myeloid

scholarly journals Th1/Th2 Cells and Associated Cytokines in Acute Hepatitis E and Related Acute Liver Failure

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Jian Wu ◽  
Yurong Guo ◽  
Xuan Lu ◽  
Fen Huang ◽  
Feifei Lv ◽  
...  
Keyword(s):  
Viral Load ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Acute Hepatitis ◽  
Hepatitis E ◽  
Th2 Cells ◽  
Upward Trend ◽  
Significant Difference ◽  
Acute Hepatitis E ◽  
Ifn Γ

Background and Aims. The involvement of cellular immunity in the development of hepatitis E virus (HEV) infection is rare. We aimed to study the roles of viral load and Th cell responses in acute hepatitis E (AHE) and HEV-related acute liver failure (HEV-ALF). Methods. We evaluated viral load and Th1/Th2 cytokine levels in 34 patients with HEV infection, including 17 each with AHE or HEV-ALF. Seventeen healthy controls (HCs) were also included who were negative for anti-HEV IgM and IgG. Results. There was no significant difference in viral load and HEV RNA in the AHE and HEV-ALF groups (both P > 0.05 ). The Th lymphocyte levels (CD3+, CD4+) in the AHE and HEV-ALF groups were significantly higher than those in the HC group (both P < 0.05 ), but there was no significant difference between the AHE and HEV-ALF groups ( P > 0.05 ). Both IFN-γ and IL-10 showed gradual upward trend from the HC group to the AHE (both P < 0.01 ), but IFN-γ showed a sharp downward trend from the AHE group to the HEV-ALF group ( P < 0.01 ) and IL-4 showed gradual upward trend from the AHE group to the HEV-ALF group ( P < 0.01 ).There was no significant difference in Th1 and Th2 cytokines between the HEV RNA(+) group and HEV RNA(-) group (all P > 0.05 ). Th2 bias was observed from the AHE ( ratio = 58.65 ) to HEV-ALF ( ratio = 1.20 ) groups. The level of IFN-γ was associated with the outcome of HEV-ALF patients. Conclusions. HEV viral load was not associated with aggravation of AHE, and the HEV-ALF patients showed significant Th2 bias, which may be involved in the aggravation of AHE.

Atypical Acute Liver Failure in Acute Myeloid Leukemia

2014 ◽  
Vol 147 (3) ◽  
pp. e3-e4 ◽  
Author(s):  
Adam E. Mikolajczyk ◽  
Shreya Sengupta ◽  
Helen S. Te
Keyword(s):  
Acute Myeloid Leukemia ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Myeloid Leukemia ◽  
Acute Myeloid

scholarly journals Lethal biliary congestive acute hepatitis E without acute liver failure: A case report

Kanzo ◽  
2021 ◽  
Vol 62 (8) ◽  
pp. 463-470
Author(s):  
Nao Yamauchi ◽  
Tetsuya Yasunaka ◽  
Akinobu Takaki ◽  
Yoshimune Hinami ◽  
Masaru Kinomura ◽  
...  
Keyword(s):  
Case Report ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Acute Hepatitis ◽  
Hepatitis E ◽  
Acute Hepatitis E

scholarly journals A Phase II of Combination Daunorubicin and Cytarabine (Ara-C) and Nilotinib (TASIGNA) (DATA) in Patients Newly Diagnosed with Acute Myeloid Leukemia and KIT Expression: Final Results

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 1443-1443
Author(s):  
Aref Al-Kali ◽  
Raoul Tibes ◽  
Jeanne Palmer ◽  
Hassan B. Alkhateeb ◽  
Mrinal M. Patnaik ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Stem Cell ◽  
Liver Failure ◽  
Phase Ii ◽  
Myeloid Leukemia ◽  
Research Funding ◽  
White Blood Count ◽  
Newly Diagnosed ◽  
Relapse Rates ◽  
Acute Myeloid

Abstract Background: Acute myeloid leukemia (AML) is an aggressive blood cancer with a wide range of response and relapse rates using standard chemotherapy combining anthracycline plus cytarabine (7+3). The stem cell receptor tyrosine kinase KIT is expressed on more than 10% of blasts in 95% of relapsed AML cases and mediates leukemic proliferation and has anti-apoptotic effects (Domen and Weissman 2000). AML with high KIT expression is associated with poorer outcome (Del Poeta, Venditti et al 2003). Goals: To study the efficacy and safety of combination 7+3 and nilotinib in patients (pts) with AML and KIT expression. Primary goal is to determine the complete response (CR) rate; while secondary goals include 2-year overall survival (OS) and disease free survival (DFS) in addition to safety. Methods: A single arm, Phase II study, enrolled pts at Mayo Clinic (MN and AZ). Appropriate IRB was obtained and study was registered (NCT 01806571). Pts were enrolled if they were newly diagnosed with AML with KIT (CD117) expression of ≥ 20% on myeloblasts by flow cytometry. KIT mutations were allowed. Nilotinib 300 mg twice daily was given on days 4-14 of induction and consolidation; and continuous daily maintenance therapy for up to 2 years. Cytarabine 100 mg/m2/day continuous IV x7 days plus daunorubicin 60 mg/m2 IV daily x3 days were used for induction, while consolidation used standard cytarabine 3 gm/m2 twice daily days 1, 3, 5 for a total of 4 cycles. This is a Simon 1-stage design with a safety analysis after enrolling 12 pts, and an interim analysis after enrolling 18 out of 43 pts (Al-Kali, ASH 2015) recommended to continue study accrual. Results: i)- Demographics: Thirty four pts were enrolled from July 2013 to June 2017. Median age was 59 years (range 24-69) with 71% being male. Median laboratory findings include hemoglobin of 8.8 gm/dL, platelets of 56 x109/L, white blood count of 3.3 x109/L (0.4-125), and peripheral blood blasts 17 %(0-94%). Cytogenetics were normal in 43% of the pts and favorable cytogenetics were seen in 6%(inv 16). FLT3 gene testing was done on 26 pts and was positive in 13%. KIT gene sequencing (exon 8, 9, 10, 11, 17) revealed pathogenic mutation in 1/28 cases (4%). ii)- Clinical outcome Out of all 34 pts enrolled on the study, 18 (53%) achieved CR (or CR with incomplete platelet recovery) with a median CR duration of 21.8 months. Of 26 evaluable pts, the overall CR rate was 69%. 4 of the 18 pts (22%) who achieved remission needed a second induction. One pt died due to liver failure (had only one dose of nilotinib and toxicity was attributed to daunorubicin). 13 (38%) pts proceeded to allogeneic stem cell transplant (HSCT), 12 of whom are alive and none were able to initiate nilotinib maintenance. Only 6 (1 had HSCT) out of 34 (18%) pts relapsed after achieving CR. Median DFS was 45.8 months, while median OS was 42.4 months. 2-year DFS and OS were 58% and 72%, respectively. iii)- Safety Thirty four pts were evaluated for adverse events (AE). Fourteen pts had G4 non-hematological AEs, including fourteen G4 AEs related to infection, 2 with electrolyte imbalances, 1 heart failure, 1 elevated bilirubin, 1 elevated lipase, and 1 jejunal hemorrhage. One patient had G5 liver failure. Most common (>20%) G3 non-hematological AEs were febrile neutropenia (56%), hypophosphatemia (21%), elevated ALT (21%) and hypertension (21%). Conclusion: Combination daunorubicin and cytarabine with nilotinib (DATA) appears to be safe and effective. Final results show an acceptable safety profile with most common AE being infection. Thirty day mortality was low (3%). DATA regimen has comparable CR rates of 53% (intent to treat) and 69% in evaluable pts. Relapse rates were very low at 18% with durable responses and encouraging survival rates. Figure. Figure. Disclosures Al-Kali: Novartis: Research Funding. Tibes:Novartis: Research Funding. Palmer:Novartis: Research Funding.

Fulminant Liver Failure Due to Acute Hepatitis E Infection in an Immunocompetent Male: A Case Report

2018 ◽  
Vol 113 (Supplement) ◽  
pp. S1322
Author(s):  
Sachit Sharma ◽  
Ashu Acharya ◽  
Alok Uprety ◽  
Abhushan Poudyal ◽  
Sadikshya Sharma
Keyword(s):  
Case Report ◽  
Liver Failure ◽  
Acute Hepatitis ◽  
Hepatitis E ◽  
Fulminant Liver Failure ◽  
Acute Hepatitis E

scholarly journals An Unexpected Cause of Recurrent Jaundice after Resolution of Acute Hepatitis E

2020 ◽  
Vol 14 (2) ◽  
pp. 415-419
Author(s):  
Annabelle Verbeeck ◽  
Ann De Becker ◽  
Hendrik Reynaert
Keyword(s):  
Acute Hepatitis ◽  
Myeloid Leukemia ◽  
Bile Ducts ◽  
Hepatitis E Virus ◽  
Liver Enzymes ◽  
Hepatitis E ◽  
Gallbladder Wall ◽  
Myeloid Sarcoma ◽  
Acute Hepatitis E ◽  
Viral Serology

In this report, we describe a rare case of liver enzyme disturbance caused by myeloid sarcoma of the gallbladder and biliary tract. A 63-year-old man with progressive chronic myeloid leukemia presented with acute hepatitis. Viral serology revealed an infection with hepatitis E virus. The liver enzymes and bilirubin improved gradually under treatment with ribavirin, but there was a flair up shortly after. Imaging including CT and echo-endoscopy showed a thickened infiltrated gallbladder wall and dilated bile ducts, suspected for myeloid sarcoma. Biopsy of an atypical skin lesion, present at the same time, confirmed the diagnosis of acute extramedullary leukemia. After induction chemotherapy, hematological improvement was seen together with a decrease of bilirubin and liver enzymes and a normalization of the bile ducts and gallbladder on imaging. However, three months later, myeloid leukemia progressed again, and the patient deceased.

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