Comunicación
Nº 056
Comunicación |
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S. Ambrosi, M.D., P. Di Zitti, M, M., A. Baiocchini, M. D.
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The patient was a 26 years-old caucasian woman. She was examined because of serologic persistence of elevated alanine aminotransferase (ALT) titers (> 100 IU/l) ten months after an episode of acute hepatitis. At that time she had only complained of slight jaundice associated with moderate astenia. The only laboratory tests showing some abnormal values were serum bilirubin {2.3 mg/dl}, serum alkaline phosphatase {45 IU/l}. and serum ALT (> 1500 IU/l). Markers for hepatitis A, B, C, D, E and G had been negative. The serum ceruloplasmin, iron and aspartate aminotransferase levels had been within normal range.
The current clinical examination was unremarkable. There was neither a history of drugs assumption or alcohol abuse nor of blood transfusion. The whole battery of the above tests was repeated showing no additional abnormalities. Antinuclear and anti-smooth muscle antibodies were negative. A core needle liver biopsy was performed. Following histologic diagnosis, serologic tests for Epstein-Barr virus, paramyxoviruses, cytomegalovirus, human immunodeficiency virus, Toxoplasma gondii were performed, and no abnormal values were detected. The patient was further followed up without receiving any treatment. Six months later an elevation of serological ALT value still persisted {70 IU/l} and a repeat liver biopsy was performed.
Haematoxilin-eosin stained histological section of the first and repeat biopsy sample were reviewed; 5* -thick sections were also immunostained for CK 8,18 (CAM 5.2 DAKO, Carpinteria, Ca., U.S.A. prediluted), CK 7 (DAKO 1:20), CK 19 (DAKO 1:50) and CD 68 (DAKO 1:40).
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