Personal site of Ph.D Roman G. Myazin

Chronic Viral Hepatitis C (first example)

Patient S–n V. V., 51, (case report 23611/834 entered the gastroenterology department of Volgograd Regional Clinical Hospital № 1 on February, 1, 2003 with complaints of periodical aching pains and a feeling of heaviness in the right hypochondrium, the deterioration of appetite and sleep, the decrease of efficiency.

The diagnosis on admission to hospital: «Chronic viral hepatitis C with syndrome of cytolysis and mesenchimal inflammation, high degree of activity». To make the diagnosis of liver disease and its activity more exact, the complex investigation of the presence of hepatitis C virus in the blood serum of the patient by the methods of Polimerase Chain Reaction (PCR) and Immune-Enzyme Analysis (IEA) were made. The diagnosis was proved by the results of PCR-diagnostics (HCV RNA « positive + », the combination of virus genotypes 1 and 3), anti-HCV Ig M «+», total antibody titer to HCV according to IEA method was 1:13600 at the moment of admission.

In past history 8 years ago when being operated on organs of small pelvis the patient was made repeated hemotransfusions. 2 months later the patient abruptly suffered low grade fever and had icteritiousness of dermal integuments and sclera, urine became dark. The patient was hospitalized to the infectious diseases hospital № 9, where extremely high levels of ALT (2,8 mkkat/l) and AST (1,7 mkmol/l) were detected, the investigation of HBV-infection markers was negative. The treatment was not held.

Since the year of 1995 the patient had periodically suffered aching pains in the right hypochondrium and high biochemical rates had been detected till in 1999 (when the patient appealed for medical aid to the infectious diseases hospital № 9 for the second time) antibodies to HCV-infection were found. Then the diagnosis was formed: «Chronic viral hepatitis C». Since 1999 the patient annually underwent courses of treatment with solution of glucose in combination with hepatoprotectors (essenciale, legalon) without any clinical effect. The patient didn't have any special antiviral treatment.

Objectively: dermal integuments and sclera are of usual staining, the lower edge of the right lobe of liver comes 2 cm out of the right costal margin edge, it is soft, the palpation is painless. The spleen isn’t palpable. According to results of the abdominal cavity ultrasound investigation: the liver tissue is of usual echogenicity, has a small-grained structure, homogeneous. The anteroposterior size of right lobe of liver is 12,7 cm, of left lobe of liver - 7,1, of caudate lobe of liver – 3,2.

The results of liver puncture biopsy: hepatocytes in the punctate, are partly saved, most of them are small-vacuolizeed. In the lobules of liver can be seen small infiltrates. In portal tracts can be observed lymphogistiocytic infiltration, compact in some places with extension to periportal zone in some sites. In the walls of biliary ducts lymphocytes are found.

Conclusion: clinical presentation of chronic viral hepatitis C of high degree of activity.  Common blood analysis: Er – 4,6´1012, Hb - 136 g/l, colour index – 0,89, Tr - 300´109, reticulocytes – 13 %, Le - 3,8´109, b -2, e - 0, band neutrophils - 3, s – 51, l – 35, m - 8. ESR – 14 mm/h. Blood clotting time – 4 min 40 sec. Blood glucose – 5,3 mmol/l. Whole protein – 87 g/l, albumins – 49 %, a1-globulins – 3 %, a2 – globulins – 11 %, b-globulins – 18 %, g-globulins – 19 %, A/G coefficient -0,96.

Coagulogramma: plasma recalcification time – 183 sec., trombotest rate – V, prothrombin index – 88 %, plasma fibrinogen – 3 g/l, fibrinogen B – feebly positive.

Clinical urine analysis: yellow, transparent, reaction – acid, relative density – 1012, glucose – not detected, protein – not detected, Le – 4-5 within eyesight, Er – not detected, plano epithelium cells – considerable number, cylinders –not detected.

Biochemical tests: MDA – 11,1 mkmol/l, DC – 1,2 u., Cat – 12,7 mkmol/ml/min, SOD – 1,3 conv.u/ml, GP – 3,06 mkmol/ml/min, SU – 0 u., SG -0,2 u., CPl – 25,6 mg%, NAG – 14,76 nmol/ml/min, total bilirubin – 22,6 mkmol/l, thymol test -3,5 u., ALT – 1,9 mkkat/l, AST – 0,62 mkkat/l.

For the purpose of detoxicant and antiviral treatment the patient underwent the monotherapy course of 10 intravenous drip infusions of Natrii Hypochloriti into the cubital vein with the speed of 20 - 30 drips per minute in the dynamically increasing concentration of the fresh-made solution from 300 to 600 mg/l as 400 ml injections in a day. The patient underwent the procedures successfully. 1 month after the finishing of the course of treatment all above-named investigations were made once again. It was detected the reduction of liver size: the lower edge of the right lobe of liver was palpable along the right costal margin edge.

According to results of the ultrasound investigation: the size of the right lobe of liver is 11,8 cm, the left lobe of liver – 6,5, the caudate lobe of liver – 3,1. Intraliver biliary ducts are not dilated. It was detected full normalization of LPO indices, liver-specific enzymes and standard liver tests. It was observed a significant increase of AOP enzymes: MDA – 7,69 mkmol/l, DC – 1,0 u., Cat – 30,69 mkmol/ml/min, SOD -3,0 conv. u./ml, GP – 4,8 mkmol/ml/min, SU - 0 u., SG – 0 u., CPl – 34,2 mg%, NAG – 11 nmol/ml/min, total bilirubin – 9 mkmol/l, thymol test -2,5 u., ALT – 0,44 mkkat/l, AST – 0,26 mkkat/l.

At the end of the course of treatment the patient noted the disappearance of aching pains in the right hypochondrium, appetite and sleep improved, the efficiency of the patient increased. The recurring testing after the course of treatment showed that HCV RNA was not detected by the method of PCR (HCV RNA « negative – »). Anti-HCV Ig M was not detected, total titer of antibodies to HCV according detected by IEA method decreased more than in 4 times (1: 3200) in comparison with the initial rate before the Natrii Hypochloriti treatment.

The recurring investigations made 3, 6, 12 months after the finishing of Natrii Hypochloriti treatmant showed the positive dynamics of all laboratory data. 1 year later HCV RNA again was not detected (HCV RNA « negative – »).



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