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Case 138

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35-year-old male patient attended in a hospital complaining of fatigue, weight loss and diarrhea for 8 months. On physical examination, he presents ascites and edema of lower limbs. There are not jaundice, rash, gynecomastia and telangiectasias. Previous history of splenectomy (hepatosplenic schistosomiasis) 11 years ago. Laboratory tests results: Albumin 2.2 g/dL; Total Cholesterol 429 mg/dL; AST 70 IU/L; ALT 71 IU/L; ALP 247 IU/L; GGT 229 IU/l. Serology positive for HBsAg, Anti-HBc IgG, Anti-HBE and Anti HAV IgG. Proteinuria (5,94g/24 hr); Urinalysis: hematuria (+ +/4 +). O&P negative.

Based on clinical history and images from microscopy, we can affirm that this patient has clinical signs of, except:

a) Nephrotic syndrome

25%

b) Hepatic insufficiency

25%

c) Portal hypertension

25%

d) Systemic congestion

25%
   

Comments

- The Brazil is an endemic country for hepatitis B and schistosomiasis.

- Portal hypertension can rise from mechanical and functional changes in the circulation of the hepatic portal venous system, which can be caused either by schistosomiasis or by hepatitis B.

- Carriers of the hepatosplenic form of schistosomiasis can develop glomerulopathy, which the diagnosis is usually late and has a bad prognosis.

- Renal injuries are more frequent and evident in HBsAg carriers.

References

- Chan TM. Hepatitis B and Renal Disease. Curr Hepatitis Rep, April 14, 2010: 99-105.

- Godoy P. Sistema urinário. In: Brasileiro-Filho G, editor. Bogliolo Patologia. Belo Horizonte: Guanabara- Koogan, 2006. p. 448-553

- Lai NK. Hepatites Related-Renal Disease. Future Virology, 2011, 6(11):1361-1376.

- Nussenzveig I, Brito T, Carneiro CRW, Silva AMG. Human Schistosoma mansoni-associated glomerulopathy in Brazil. Nephrol Dial Transplant, 2002: 4-7.

- Ranalli TV, et al. Liver schistosomiasis: an unexpected finding in hepatitis B virus-related hepatitis. International Journal of Infectious Diseases, 2008: e67-e70.

- Velthuysen MIF, Florquin S. Glomerulopathy Associated with Parasitic Infections. Clinical Microbiology Reviews, Jan 2000: 55-66.

- Eng-Kion T. Epidemiology, transmission, and prevention of hepatitis B virus infection. Walthman (MA): UpToDate; 2013. Available at: http://www.uptodate.com/contents/epidemiology-transmission-and-prevention-of-hepatitis-b-virus-infection

Authors

Bárbara de Queiroz e Bragaglia, 5th year medical student at UFMG School of Medicine

E-mail: barbaraqueiroz[at]ufmg.br

Daniele Araújo Pires, 5th year medical student at UFMG School of Medicine

E-mail: dani_arp[at]hotmail.com

Eduardo Gomes Campanati, 6th year medical student at UFMG School of Medicine

E-mail: duducampa[at]hotmail.com

Supervisors

Prof Luciana Diniz Silva, gastroenterologist, professor of the Department of Clinical Medicine at UFMG School of Medicine

E-mail: lucianadinizsilva[at]gmail.com

Reviewers

Glauber Eliazar, Luanna Monteiro, Marina Leão, Cinthia Barra, Prof Viviane Parisotto, Hercules Riani

Translated by

Hercules Hermes Riani Martins Silva, 5th year medical student at UFMG School of Medicine

E-mail: herculesriani[at]gmail.com

Commentics

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