PubMed · 4857191
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J W Hampton. 1974. Bleeding disorders during surgery.. https://doi.org/10.1097/00004311-197401210-00011
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PATHOGENESIS: The pathogenesis of Behcetp3disease is still unknown, although a genetic predisposition appears to play an important role with a strong association with the MICA gene located between the HLA-B and TNF genes rather than HLA B51. Abnormal immune responses affect especially cellular immunity and significant T-cell proliferative responses by the gamma ô subset of T cells are shown after stimulation with heat shock protein peptides. Systemic levels of the soluble TNF R-75 and IL 12 could be the best biological markers of disease activity. NEW THERAPEUTIC APPROACHES: Systemic colchicine being implicated in polynuclear neutrophil over-production of toxic super-oxides, its prescription for controlling eye involvement should be reevaluated. Steroids and immunosuppressive drugs are still the treatment of choice for severe manifestations of the disease. Beneficial effects of cyclosporine are established in uveitis. Tacrolimus (FK 506) and pentoxifylline may be valuable.
HISTORY AND ADMISSION FINDINGS: A 69-year-old man, a known carrier of hepatitis B virus (HBV) after blood transfusion, developed increasingly severe jaundice with high transaminase levels after receiving steroids in high doses. Significant preceding conditions included chronic obstructive pulmonary disease, coronary heart disease, ulcerative colitis in remission and diabetes mellitus. On admission he was jaundiced and experienced pain on pressure below the right costal margin. INVESTIGATIONS: Serology demonstrated reactivated hepatitis B with an increase of the HBV-DNA concentration in serum, as well as seroconversion with HBe antigen, anti-HBc-IgM antibodies and absence of anti-HBe antibodies. DIAGNOSIS, TREATMENT AND COURSE: The history and serological findings indicated reactivation of the hepatitis B by the steroid treatment. Progressive liver failure developed. A marked reduction of virus particles in the blood occurred after a therapeutic trial with the nucleoside analog lamivudine, but the patient died of liver failure 30 days after admission. CONCLUSION: Steroids should be given to known hepatitis B carriers only if strictly indicated, because of the danger of acute deterioration of liver functions by reactivation of the disease with possibly fatal consequences. If steroids are administered, liver functions and serological hepatitis markers should be closely monitored so that any necessary treatment can be quickly initiated.