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XXIII Annual Meeting of the Latin American Association for the Study of the Liver and the National Congress of the Mexican Association of Hepatology

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XXIII Annual Meeting of the Latin American Association for the Study of the Liver and the National Congress of the Mexican Association of Hepatology ABSTRACT SECTION September-October, Vol. 13 No.5, 2014: 621-711 XXIII Annual Meeting of the Latin American Association for the Study of the Liver and the National Congress of the Mexican Association of Hepatology September 11-13, 2014. Cancun, Quintana Roo, Mexico. Poster Presentations to mixed ethnia, without family history of hepatitis neither A. CASE REPORT personal history of hepatitis. The female patient acquired vi- rus infection via transfusion and the male patient via unsafe 001 sex apparently (Table). Comments. We describe evidence of circulation of HBV/HDV in our region and the first cases defi- FIRST CASES OF ACUTE HEPATITIS HBV/HDV IN nition of severe acute coinfection HBV/HDV in Argentina. ARGENTINA. CASE REPORT The female was treated with LAM 3 months. None needed liv- er transplant and they normalized their lab after 21 days. CARLOSAR REMONDEGUI,EM *** SUSANA CEBALLOS,L *** JORGERE GONZALEZZ ****** Both seroconverted HBeAg and then HBsAg at 3 months of *SERVICIO DE INFECTOLOGÍA & MEDICINA TROPICAL. HOSPITAL SAN ROQUE. JUJUY. follow-up. It is well known, that HBV/HDV coinfection is as- ARGENTINA. sociated with a higher rate of severe even fulminant acute **SERVICIO HEPATITIS Y GASTROENTERITIS, DEPARTAMENTO VIROLOGÍA, presentation comparing with HBV infection alone. We used to INEI-ANLIS. ARGENTINA. see 35% of acute cases of HVB with severe clinical presenta- tion reported at XX Congress ALEH 2008. Now we have to The prevalence of HBV infection in our region is relatively think in HBV/HDV coinfection as a probably cause of this high. The Jujuy province is located northwest in Argentina, high percentage of severe acute presentation. in a Subtropical Region, bordering with Bolivia and Chile. In- side our province in the Yungas biosphere, there were foci of 002 high prevalence HBsAg 4%, antiHBc 26% in blood donors. Now days this percentages decreased substantially to 1 and SOFOSBUVIR, RIBAVIRIN AND PEGINTERFERON AS 9% respectively, due to national vaccination against HBV A SUCCESSFUL TREATMENT FOR FIBROSING since 14 years ago. According to our previous publication CHOLESTATIC HEPATITIS AFTER LIVER HBV genotype F seems to be prevalent also in our province, J Clin Virol 2008. This region population is Amerindians be- TRANSPLANTATION: A CASE REPORT IN A longing to Guaraní culture mixed with Europeans. In Latin MEXICAN TRANSPLANT CENTER America, western Amazonia is a highly endemic area where E. NEGRETE-CARBALLO, J.M.M ANTOLINEZ-MOTTA,O , hepatitis D is prevalent. Non-safe sexual activity seems to be J. AGUIRRE-VALADEZ,U ED L.R.. VALDOVINOS-GARCÍA,A, A. RAMIREZ-POLO, the most important transmission route. There are no reports A. CONTRERAS-SALDIVAR,RS - VA M. VILATOBA-CHAPA,AT C I.I GARCÍA-JUÁREZC ÁR of HDV circulation in our region neither description of acute DEPARTMENT OF GASTROENTEROLOGY, INSTITUTO NACIONAL DE CIENCIAS cases of HBV/HDV coinfection in Argentina. However there MÉDICAS Y NUTRICIÓN SALVADOR ZUBIRÁN, MEXICO CITY, MEXICO. are scarce published studies of HDV prevalence in blood do- nors and Amerindian communities from Northeast region of Introduction. Hepatitis C virus (HCV) recurrence after liver Argentine. We here describe two young patients with severe transplantation (LT) is universal. Fibrosing cholestatic hepa- acute hepatitis coinfection. Both from Yungas area, belonging titis (FCH) is a severe form of recurrent HCV marked by an aggressive progression of cholestasis and development of fi- Table. (001) Sex. brosis leading to accelerated graft loss and/or death. Pegylated interferon (PEG) and ribavirin (RBV) as combined therapy Male Female has been used in selected LT recipients with moderate to se- vere recurrent HCV but is limited by frequent side effects and Age 23y 28y low antiviral efficacy. Sofosbuvir (SOF), an inhibitor of the Tattoo yes no HCV NS5B polymerase has been shown to be effective in com- Days of symptoms 20 10 bination with RBV, with or without PEG, in patients with ALT increased UL x38 x37 HCV infection of all genotypes (GT). Material and meth- AST increased UL x32 x18 ods. We report a case of a patient with FCH following LT, MELD 24 28 SOF/RBV/PEG therapy was elected, so far 14 of 24 weeks are HBsAg pos pos aHBc IgM pos pos completed. Results. A 61-year-old man with cirrhosis related aHBc IgG pos pos to a HCV GT2 infection resistant to standard therapy who de- HBeAg pos neg veloped hepatocarcinoma during pre-transplantation period aHBe pos pos underwent LT in November 2013. At the time of LT, his HCV aHDV pos pos RNA level of 322,222 IU/mL. Four weeks after he developed LAM no yes jaundice and the liver function tests (LFT) were noted to be 622 Poster Presentations. XXIII Annual meeting of the Latin American association for the study of the liver. , 2014; 13 (5): 621-711 abnormal with a total bilirubin 6.94 mg/dL, aspartate ami- transfusions and decreased alphafetoprotein (AFP) levels. notransferase 389 U/L, alanine aminotransferase 850 U/L, al- Case report. We describe two HCC spontaneous involution kaline phosphate 299 U/L, gamma-glutamyl transpeptidase cases in two patients. The first case was a 72 years-old man 1317 U/L and HVC RNA level 3,000,000 IU/mL. A MRI with liver cirrhosis by hemochromatosis. He had a typical cholangiography and ERCP were performed showing evi- HCC lesion on RMN of 14 mm at VII liver segment. This le- dence of a biliary stricture and a 10F plastic stent was placed. sion was not visualized on CT previous to RFA. The second Liver biopsy revealed four portal tracts with mild portal and one, was a 52 years old man with cryptogenic cirrhosis, the centrilobular inflammation, pericholangitis, cholestasis and CT demonstrated a 5 cm typical lesion in segment II. In the focal endothelitis. The LFT remained abnormal, his HVC second CT, the lesion reduce to 3 cm. Previously PEI proce- RNA level increased reaching 13,000,000 UI/mL and a new dure, the lesion disappeared. The AFP levels reduction and liver biopsy showed features of FCH. On February 2014 SOF/ absence of metastatic disease was demonstrated in both cases. PEG/RBV was initiated. The patient developed anemia, leuko- The patients continues ambulatory monitoring, with radiolog- penia (requiring GCSF), thrombocytopenia, dyspeptic symp- ic and laboratory surveillance, without HCC. Discussion. The toms and severe malaise; mycophenolate mofetil was stopped spontaneous regression of HCC lesion is a rare phenomenon. and the dose of PEG and RBV were adjusted. His liver tests The surveillance and the radiology approach previously any began to improve by week one and were normal at week 10 as treatment is very important because it could demonstrate the his general condition. After 12 weeks of treatment, the HVC lesion involution. RNA level was undetectable. During treatment blood levels of tacrolimus remained stable. Further follow-up will be given at 004 the meeting. Conclusion. We report the first case of a Mexi- can patient with cholestatic HCV recurrence following LT JAUNDICE AND ABNORMAL LIVER FUNCTION TEST treated with the promising SOF-based regimen which resulted AS FIRST MANIFESTATION OF DIFFUSE LARGE B in notable clinical improvement, disease stabilizer and rapid CELL LYMPHOMA. A CASE REPORT suppressor agent of HCV replication lacking of interaction with immunosuppressive medications as reported in previous MAM.A. PEÑALOZA-POSADA,*** GG. BARRANCO-LAMPON,L ****** literature. C.. RAMOS-PEÑAFIEL,S- ,****** E. PÉREZ-TORRES*PÉR R *GASTROENTEROLOGY DEPARTMENT. HOSPITAL GENERAL DE MÉXICO EDUARDO 003 LICEAGA. MÉXICO, D.F. **HEMATOLOGY DEPARTMENT. HOSPITAL GENERAL DE MÉXICO EDUARDO LICEAGA. MÉXICO, D.F. ATYPICAL BEHAVIOR OF HEPATOCELLULAR CARCINOMA: SPONTANEOUS Introduction. Diffuse large B cell lymphoma (DLBCL) is the REGRESSION, TWO CASE REPORT most common form of no-Hodgkin lymphoma. The average age at time of diagnosis is 60 years, more frequently in men. *** *** *** A. RAMÍREZ-POLO,E P , L.. VALDOVINOS,AL O J. AGUIRRE-VALADEZ,U E- , Often is a painless rapid swelling in the neck, armpit, or groin EE. MUÑOZ,*** M. VILATOBÁ,****** A. TORRE,O ********* A. GONZÁLEZ,Á ************ which is caused by enlarged lymph nodes, with night sweats, I. GARCÍA-JUÁREZ**ARJ U EZ *DEPARTAMENTO DE GASTROENTEROLOGÍA. **DEPARTAMENTO DE TRASPLANTES. fever and weight loss. Is an aggressive (fast growing) lympho- ***DEPARTAMENTO DE HEPATOLOGÍA. ****DEPARTAMENTO DE RADIOINTERVENCIÓN, ma and is fatal if left untreated, but with timely and appropri- INSTITUTO NACIONAL DE CIENCIAS MÉDICAS Y DE LA NUTRICIÓN SALVADOR ate treatment, 60% of all patients can be cured. 10% of the ZUBIRÁN, MÉXICO, D.F. cases developed hepatic dysfunction and jaundice as manifes- tation with alcohol consumption and viral hepatitis as associ- Background. Hepatocellular carcinoma (HCC) is the most ated risk factors. Anthracycline-based chemotherapy cannot common liver tumor; it is the second leading cause of death in be safely administered in these setting, so an alternative regi- patients with cancer and the fifth leading cause of cancer in mens are required. Successful use of dexamethasone, cytarab- men and the seventh in women. Prevalence is high in regions ine and cisplatin (DHAP) as part of initial therapy is use until where Hepatitis B virus (HBV) infection is endemic, with sub- hepatic function normalized and standardar treatment can be Saharan Africa and East Asia prevalence reports to 20 cases administrated known as CHOP. Case report. Female 57 per 100,000. In Mexico, the incidence is 5 and 4.9 cases per years old. History of moderate to heavy alcohol consume and 100,000 habitants, for male and female respectively. In North arterial hypertension. Presented with jaundice, fever, asthe- America and Europe regions, principal risk factor is hepatitis nia, adinamia and significative weight loss, abnormal liver C coinfection (HCV). Between 80 to 90% of HCC cases are re- function test with total bilirubine of 8.29 md/dl, a alanine ami- lated to cirrhosis.
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