Fatal marrow aplasia associated with non-A non-B hepatitis.

نویسندگان

  • P Bannister
  • K Miloszewski
  • D Barnard
  • M S Losowsky
چکیده

swellings have not been reported. The condition is a multisystem disease with a mortality rate of up to 63%, death being due to either respiratory failure or the development of a malignant lymphoma.' An immunological basis for the disease has been suggested because of extensive immunological dysfunction found in a recent study of six patients.3 The aetiology is unknown but, interestingly, although the disease is often recognised in America, it has never been reported in Britain. It is unlikely that it has been consistently mistaken for some other infiltrative lung disease, such as Wegener's granulo-matosis or histiocytosis X, but this is possible. The radiological appearances are not diagnostic but the multisystem abnormalities and histological appearances of the lung should enable the diagnosis to be made. Steroid responsiveness appears to be a good prognostic factor, and adding cyclophosphamide may be of benefit.4 Aplastic anaemia is a rare, late complication of viral hepatitis. Over 200 cases have been reported, but only recently have the virological studies been carefully documented. Hepatitis A and hepatitis B viruses have been implicated, and two possible cases of non-A, non-B hepatitis complicated by marrow aplasia have been reported.' 2 We report a case of hepatitis that was followed by fatal aplastic anaemia; virological studies suggested that it was non-A, non-B hepatitis. Case report A 15 year old schoolgirl was admitted to hospital with a two week history of malaise and anorexia followed by deepening jaundice with the passage of dark urine and pale stools. She had not been exposed to a jaundiced patient, drugs, or other hepatotoxic agents. She had not been abroad, had had no injections, and did not have tattoos, pierced ears, or any known source of parenteral infection. Examination showed her to be deeply jaundiced with no signs of chronic liver disease. There was moderate smooth hepatomegaly, and the spleen was just palpable. Biochemical investigation showed a serum aspartate transaminase activity of 900 IU/1, a serum bilirubin concentration of 480 tsmol/l (28 mg/100 ml), but a normal alkaline phosphatase activity. Haemoglobin concentration and white cell and platelet counts were normal. Virological screening for all hepatitis A and B antigens and antibodies yielded negative results on two occasions. Assay of paired sera for influenza virus, cytomegalovirus, adenovirus, Coxiella burnetii, Mycoplasma pneu-moniae, and Epstein-Barr virus showed no evidence of recent or past infection by these agents. The subsequent clinical course showed a prolonged cholestatic phase; results …

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عنوان ژورنال:
  • British medical journal

دوره 286 6374  شماره 

صفحات  -

تاریخ انتشار 1983