食道静脈瘤破裂を伴ったLupoid肝炎の1手術例

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A case of lupoid hepatitis with portal hypertension was reported. This patient was 23-year old woman, She was admitted to a hospital with complaining of jaudice, high fever and ascites about 3 years ago. Laboratory examination in the hospital revealed abnormalities of liver function and positive L.E. cell phenomenon. She was treated with predonisone on suspicious of SLE for 2.5 years. There was an improvement of these symptoms but suddenly, hematoemesis from esophageal varices occured. Transabdominal esophageal transection with devascularization of esophago-gastric region and splenectomy was performed because of reccurent bleeding from esophageal varices. During operation, the spleen was markedly enlarged and weighed 1, 440g and liver cirrhosis with multiple nodules was observed. Portal pressure was 400mm H2O. Microscopic examination demonstrated coarsely nodular pseudolobules and marked infiltration with lymphocytes and plasma cells in the liver and numerous prominant lymphoid follicle in the spleen. By orcein staining, HBs antigen of the liver specimens could not be found. Preoperative laboratory data inculuded, hemoglobin, 7.9g/100ml, WBC, 1, 700/mm3 and platelet count, 33, 000/mm3. The total serum protein was 6.8g/100ml with albumin 2.2g/100ml and gamma globulin 3.5g/100ml. Immunological studies showed high value of IgG and low level of C3, C4 (third and fourth components of the complement system). The latex agglutination antinuclear antibody and antismoothmuscle antibody reaction was positive but the L.E. cell phenomenon and antimitochondrial antibody reaction was negative. Moreover, a decreased B-cell population and reduced PHA responsiveness of peripheral lymphocytes was observed. Many serological and immunological abnormalities were noticed in this patient. From these results, lupoid hepatitis with portal hypertension was diagnosed. It has been reported to explain that portal hypertension with splenomegaly in this disease is due to obstruction of portal venous blood flow. However, it is suggested that immunological disorders may be related to portal hypertension with splenomegaly.

食道静脈瘤破裂を伴ったLupoid肝炎の1手術例

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