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GIANT CELL HEPATITIS IN BRITISH COLUMBIA: THE EXPERIENCE IN A TERTIARY HEPATOLOGY AND LIVER TRANSPLANTATION CENTER
J Shah, U Steinbrecher, S Erb, S Tha, EM Yoshida
Division of Gastroenterology and Department of Pathology, University of British Columbia
Giant cell hepatitis (GCH) is a rare form of hepatitis that can progress to fulminant liver failure and has a generally poor prognosis. The etiology of GCH includes viruses including typical viral hepatitis, cytomegalovirus, rubella, parvovirus, paramyxovirus, human herpes virus, and human papilloma virus. Other etiologies include autoimmune disorders and drug toxicities. Successful treatment of GCH with ribavirin and/or interferon has been described. We report on a case series of three patients with GCH evaluated at the University of British Columbia.
CASE 1: 63 year old man with chronic lymphocytic leukemia who developed acute hepatitis with evidence of significant liver dysfunction. Liver biopsy revealed syncytial giant cells; paramyxovirus was the suspected etiology. He was started on treatment with ribavirin and had an initial response with improvement of his liver enzymes.
CASE 2: 18 year old man who underwent liver transplantation at the age of 10 months due to GCH. He was well for several years after transplantation with a maintenance regimen of prednisone, azathioprine, and cyclosporine. At age 18, he developed an elevation of his liver enzymes. Subsequent liver biopsy showed recurrent GCH with no obvious etiology. No treatment was initiated and his liver enzyme abnormalities improved but did not return to normal. His liver function remains largely intact.
CASE 3: 22 year old man who presented with fulminant liver failure requiring urgent liver transplantation. A Hepatitis B core antibody positive graft was used and he received one year of lamivudine post-transplant. Anti-rejection therapy included prednisone, tacrolimus, and azathioprine. Six years later he developed GCH with no obvious etiology.
CONCLUSION: GCH is a recognized entity in British Columbia in both non-transplant and transplant patients. The etiology remains obscure in most cases despite extensive investigations. We have had success with ribavirin therapy in the treatment of GCH although expectant management and close observation can be used.