[CIS-PAGID] question for increase liver enzyme in a pt with CVID

[fabrício prado monteiro]

Hepatitis C, is possible!

On 31 May 2011 22:15, YaeJean Kim <yaejeankim at skku.edu> wrote:


> Dear all,

>

> I recently received a consultation on a 26 yo female who was diagnosed with

> CVID and on monthly IVIG.

> Her liver enzyme suddenly rose to 600/540 U/L (AST/ALT) last month. Her

> liver ez had been normal before.

>

>

> Additional hx:

> She was also diagnosed with ulcerative colitis by GI people at other

> institution (she has been f/u for GI issue at other place). -> She has been

> on mesalazie for this.

> She also received splenectomy at other hospital in 2008 -> for this she has

> been on antibitc prophylaxis (first with augmentin, but stopped due to GI

> problem, then swithced to 3rd generation cephalosporin, cefditoren more than

> a year)

> There is a hx of histiocytosis and bronchiectasis.

> Hx of EBV associated multiple lymphadenopathy in the abdomen, in the neck,

> mediastitum...(bx in 2009 showed EBV positive in a few cells *but no*malignancy, no granuloma -> so no action was taken for LN issues and her

> condition appears stationary)

> Recurrent intermitten parotitis and urticaria-> now ok for a while

>

>

> When I saw her with increased liver ez at 632/628 (AST/ALT) in May 13,* I

> discontinued the antibiotics first and the liver enzymes were still high at

> 622/540 after two weeks of antiboitc discontinuation.*

> Her liver US in March 2011 showed mild hepatomegaly, still variable sizes

> of LNs in the abdominal cavity (some increased, some decreased in sizes when

> compared to previous ones).

>

> During communication, I* found that she started VSL#3 for UC recommended

> by her GI doctor at other instituion, a probiotics a month ago*.

> With that, she reports that her bowel sx are improved.

>

> Here are my questions that I hope to learn from you.

>

> Do you usually use probiotics in patients with PID such as in this case and

> associated inflammatory bowel disease presentation?

> Any specific experience with probiotics in patients with CVID and UC?

> Any comments or experience on particular aspects of VSL#3 in this setting?

> Can this cause increase liver enzyme?

>

> Thanks in advance.

>

> YaeJean

>

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> --

> Yae-Jean Kim, MD

> Assistant Professor

> Division of Infectious Diseases

> Department of Pediatrics

> Sungkyunkwan University School of Medicine

> Samsung Medical Center

> 50 Irwon-dong Gangnam-gu

> Seoul, Korea

> Tel)  +82-2-3410-0987  Fax) +82-2-3410-0043

> yaejeankim at skku.edu

>

>



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