Orthotropic Liver Transplantation for Acute Intrahepatic Cholestasis in Sickle Cell Disease: Clinical and Histopathologic Features of a Rare Case
| Autor: | Jessica Tracht, Shu Kwun Lui, Rushikesh Shah, Alyssa M. Krasinskas |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Adult
Male 0301 basic medicine medicine.medical_specialty Biopsy medicine.medical_treatment Cell Anemia Sickle Cell Cholestasis Intrahepatic Disease Liver transplantation Gastroenterology Pathology and Forensic Medicine 03 medical and health sciences Extracorporeal Membrane Oxygenation 0302 clinical medicine Fulminant hepatic failure Cholestasis Internal medicine Rare case medicine Humans Hyperbilirubinemia business.industry Acute Kidney Injury medicine.disease Liver Transplantation 030104 developmental biology medicine.anatomical_structure Liver 030220 oncology & carcinogenesis Acute Disease Surgery Anatomy business Liver pathology |
| Zdroj: | International Journal of Surgical Pathology. 27:411-417 |
| ISSN: | 1940-2465 1066-8969 |
| DOI: | 10.1177/1066896918798467 |
| Popis: | Sickle cell disease has a wide range of hepatic manifestations, with acute intrahepatic cholestasis being one of the rarest and most fatal, often resulting in acute fulminant hepatic failure. Liver transplantation is an emerging but rarely utilized treatment for hepatic failure in the setting of sickle cell disease. Few such cases have been reported in the literature, with little emphasis on histopathologic correlation. We report a case of acute intrahepatic cholestasis in a patient with sickle cell disease who underwent orthotropic liver transplantation and describe novel correlating histopathologic features. The patient is a 29-year-old man who presented with hyperbilirubinemia, acute kidney injury, and coagulopathy. He was diagnosed clinically with acute intrahepatic cholestasis and received an orthotropic liver transplant. The explanted liver demonstrated marked sinusoidal expansion by sickled erythrocytes, hyperplastic Kupffer cells, and extramedullary hematopoiesis. There was extensive sinusoidal and centrizonal fibrosis with occlusion of central veins reminiscent of chronic sinusoidal obstructive syndrome, a previously undescribed pattern of injury. This case represents one of the few reported cases of sickle cell intrahepatic cholestasis treated by transplantation and demonstrates the rarely reported histopathologic features and gives insight to a potentially new mechanism of injury in these patients. Familiarity with the morphologic features of sickle cell hepatopathy and its clinical manifestations is important as transplantation in sickle cell–related liver injury increases in frequency. |
| Databáze: | OpenAIRE |
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