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Peliosis Hepatis


Presentation

  • The present report concerns a postpartum patient in whom peliosis hepatis initially presented as active intraperitoneal hemorrhage from peliotic liver lesions, with no obvious etiology.[ncbi.nlm.nih.gov]
  • The present report concerns two previously healthy young children in whom peliosis hepatis initially presented as acute hepatic failure and who had Escherichia coli pyelonephritis.[ncbi.nlm.nih.gov]
  • In this case report, ominous results of clinically misdiagnosed PH have been presented. PH should be kept on mind in all patients with hepatic mass, especially presented by sudden onset distention of the abdomen.[ncbi.nlm.nih.gov]
  • We present a 10-year-old boy with Fanconi anemia who presented with peliosis hepatis due to androgen treatment. Magnetic resonance (MR) imaging revealed multiple non-enhancing masses.[ncbi.nlm.nih.gov]
  • We report an autopsy case of a 28-year-old woman with severe developmental delay who presented to the emergency department with hemoperitoneum due to massive liver rupture and subsequently died without a diagnosis.[ncbi.nlm.nih.gov]
Fever
  • A 31-year-old woman was admitted because of persistent remittent fever. Tricuspid valve endocarditis due to Staphylococcus aureus was identified as the cause of fever.[ncbi.nlm.nih.gov]
  • Rochalimaea henselae, recently recognized to cause persistent fever and bacteremia in immunocompetent and immunocompromised persons, also causes bacillary angiomatosis and parenchymal bacillary peliosis.[ncbi.nlm.nih.gov]
  • In this article, we report the case of a 36-yr-old patient presenting with manifestations of portal hypertension, hepatic dysfunction, and fever who proved to have peliosis hepatis on liver biopsy. A thorough work-up revealed no obvious etiology.[ncbi.nlm.nih.gov]
  • The patient was diagnosed with peliosis hepatis based on his medical history of having been bitten by a dog, presence of mild anemia, and lack of characteristic symptoms, including fever of unknown origin, abdominal pain, and hepatosplenomegaly, combined[ncbi.nlm.nih.gov]
  • Each patient had had an episode of jaundice with fever in the past. At peritoneoscopy, the lesions appeared as reddish-purple spots measuring up to 2.0 mm in diameter.[thieme-connect.com]
Constitutional Symptom
  • Clinically, most of these patients presented with constitutional symptoms such as weight loss and fever in addition to gastrointestinal symptoms or abdominal pain. Hepatomegaly was present in all cases.[doi.org]
HELLP Syndrome
  • Spontaneous hepatic rupture (SHR) during pregnancy is a rare but well known complication and it usually occurs alongside eclampsia or HELLP syndrome.[ncbi.nlm.nih.gov]
Nausea
  • Case History, Patient 2 A 37-year-old woman presented with acute onset of epigastric and right upper quadrant pain, with associated nausea, vomiting and exacerbated gastroesophageal reflux.[file.scirp.org]
Vomiting
  • Case History, Patient 2 A 37-year-old woman presented with acute onset of epigastric and right upper quadrant pain, with associated nausea, vomiting and exacerbated gastroesophageal reflux.[file.scirp.org]
Hepatomegaly
  • The cause of the huge hepatomegaly encountered in the present case may be attributable to peliosis due to severe infection.[ncbi.nlm.nih.gov]
  • A 54-year-old man who presented with marked hepatomegaly and a liver scan suggestive of an infiltrative malignancy was found to have peliosis hepatis caused by androgenic steroids.[ncbi.nlm.nih.gov]
  • We emphasize that, although it is rare, peliosis hepatis should be considered in long-term haemodialysis and renal transplant patients who exhibit hepatomegaly and/or splenomegaly and/or disordered liver function (in particular, elevation of hepatic alkaline[ncbi.nlm.nih.gov]
  • Her symptoms included abdominal pain and weight loss; the only finding of a physical examination was hepatomegaly. We performed computed tomography (CT) and magnetic resonance imaging (MRI) of the liver and a liver biopsy.[ncbi.nlm.nih.gov]
  • Although liver function was normal in all patients before therapy was started, all but one patient developed hepatomegaly or signs of hepatic toxicity.[annals.org]
Jaundice
  • A 75-year-old man was admitted for evaluation of marked edema and jaundice. Serum total bilirubin was elevated above 20 mg/dl.[ncbi.nlm.nih.gov]
  • A patient with acute myeloblastic leukaemia developed jaundice revealing peliosis hepatis after receiving 6-thioguanine for two months. Peliosis hepatis was severe and was associated with mild lesions of centrilobular veins.[ncbi.nlm.nih.gov]
  • Some patients develop overt liver disease, characterized by jaundice , hepatomegaly, and liver failure. Mild cases may be detected incidentally during imaging tests done because liver function test results are slightly abnormal or for other reasons.[msdmanuals.com]
  • Some patients develop overt liver disease, characterized by jaundice, hepatomegaly, and liver failure. Mild cases may be detected incidentally during imaging tests done because liver function test results are slightly abnormal or for other reasons.[msdmanuals.com]
  • Some patients develop overt liver disease, characterized by jaundice, hepatomegaly, and liver failure.[univadis.co.uk]
Cutaneous Manifestation
  • A review is presented of the cutaneous manifestations of giant lymph node hyperplasia.[ncbi.nlm.nih.gov]
  • She was diagnosed with lupus when she was 19 years old, having symptoms of arthritis, nephritis, transverse myelitis, thrombocytopenia and cutaneous manifestations.[scielo.br]
Xanthoma
  • A patient is described who had generalized plane xanthomas, cutaneous vasculitis, peliosis hepatis, and intraabdominal giant lymph node hyperplasia of the plasma cell type.[ncbi.nlm.nih.gov]

Workup

  • Hematologic workup was compatible with peripheral sequestration or loss of blood cells; however, there was no evidence of gastrointestinal or other sources of hemorrhage, and the only significant finding was a progressive liver enlargement.[ncbi.nlm.nih.gov]
Liver Enzymes Abnormal
  • Liver enzyme abnormalities were not detected throughout the entire course of therapy. The liver biopsy specimen revealed peliosis hepatis. Treatment with panipenem/betamipron was successful, although recurrent septic pulmonary embolism occurred.[ncbi.nlm.nih.gov]
Liver Biopsy
  • Liver biopsy is necessary to establish diagnosis. By withdrawing the offending drug or treatment of the underlying disorder, regression may be observed.[ncbi.nlm.nih.gov]
  • After the liver biopsy or laparoscopy, the patients were discharged and followed up in the clinic. Both patients were followed up for at least 1 year with good recovery.[ncbi.nlm.nih.gov]
  • Eight group 2 patients underwent serial liver biopsies, which showed disappearance of vascular hepatic disease in 6 patients and persistence in 2.[ncbi.nlm.nih.gov]
  • In this article, we report the case of a 36-yr-old patient presenting with manifestations of portal hypertension, hepatic dysfunction, and fever who proved to have peliosis hepatis on liver biopsy. A thorough work-up revealed no obvious etiology.[ncbi.nlm.nih.gov]
  • The liver biopsy under laparoscopy revealed marked sinusoidal dilatation and retention of red blood cells, which was consistent with a diagnosis of peliosis hepatis.[ncbi.nlm.nih.gov]

Treatment

  • We suggest avoiding or interrupting treatment with androgens in patients preparing for BMT.[ncbi.nlm.nih.gov]
  • Awareness of this condition and the available treatment modalities may lead to favorable outcomes in future cases.[ncbi.nlm.nih.gov]
  • Based on these findings plus clinical observations, she was diagnosed with peliosis hepatis and her steroid treatment was terminated.[ncbi.nlm.nih.gov]
  • Because of reduced liver function and treatment-resistant ascites, he underwent liver transplantation without a definite preoperative diagnosis.[ncbi.nlm.nih.gov]
  • The clinical picture began resolving shortly after treatment with zidovudine and ampicillin/sulbactam was started and had totally resolved 6 months after presentation.[ncbi.nlm.nih.gov]

Prognosis

  • […] general: T1: typically hypointense (unless complicated by recent hemorrhage) T2: hyperintense C (Gd): enhancement is typical, and is usually centrifugal (from center outward) Angiography/DSA hypervascular with multiple vascular nodules Treatment and prognosis[radiopaedia.org]

Etiology

  • The diagnosis of peliosis hepatis was based on liver biopsy results which were suggestive of tuberculous etiology.[ncbi.nlm.nih.gov]
  • It may be related to several etiologic conditions, especially infections and toxicity of immunosuppressive drugs. To our knowledge, there are only three articles reporting the association between peliosis hepatis and systemic lupus erythematosus.[ncbi.nlm.nih.gov]
  • Autopsy findings suggested that dilatation of sinusoids with slow progressive injury of sinusoidal endothelium and hepatocytes due to unknown local and general etiologic factors may be an initial mechanism in the development of peliosis hepatis.[ncbi.nlm.nih.gov]
  • A thorough work-up revealed no obvious etiology. At autopsy, malignant histiocytosis of the liver and bone marrow was diagnosed.[ncbi.nlm.nih.gov]
  • Although the etiology is unknown the condition may be associated with several disease states and medications.[ncbi.nlm.nih.gov]

Epidemiology

  • EPIDEMIOLOGY The epidemiology of peliosis hepatis is incompletely understood since many patients are asymptomatic and remain undiagnosed. Peliosis hepatis is often an incidental finding on abdominal imaging or autopsy.[uptodate.com]
  • "Molecular epidemiology of bartonella infections in patients with bacillary angiomatosis-peliosis". N. Engl. J. Med. 337 (26): 1876–83. doi : 10.1056/NEJM199712253372603. PMID 9407154.[en.wikipedia.org]
  • The epidemiology and pathophysiology of PH is not completely understood since most patients are asymptomatic and remain undiagnosed. It is usually an incidental finding on abdominal imaging or autopsy.[gut.bmj.com]
Sex distribution
Age distribution

Pathophysiology

  • […] transplants: It can be found in up to 20% patients, can be related to azathioprine or cyclosporine use, and may be associated with increased risk of transplant rejection. [9] [10] Drugs and toxins: Corticosteroids, androgens, azathioprine, tamoxifen [11] Pathophysiology[en.wikipedia.org]
  • The epidemiology and pathophysiology of PH is not completely understood since most patients are asymptomatic and remain undiagnosed. It is usually an incidental finding on abdominal imaging or autopsy.[gut.bmj.com]
  • Pathophysiology It is not clear why and how peliosis hepatis occurs.[heydoctor.org]

Prevention

  • The main aim is to prevent the risk of a sudden bleeding that, in absence of properly equipped structures, may have a fatal outcome.[ncbi.nlm.nih.gov]
  • We decided to operate by means of diagnostic and therapeutic means by which we could prevent future bleeding complications.[ncbi.nlm.nih.gov]
  • Retrospective case identification or complicating clinical factors prevent us from drawing conclusions about the efficacy of antibiotic therapy in many of the cases.[doi.org]

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