{"id":1950,"date":"2012-10-01T01:00:00","date_gmt":"2012-10-01T00:00:00","guid":{"rendered":"https:\/\/angh.net\/abstracts\/une-cholestase-inexpliquee\/"},"modified":"2018-10-20T18:40:04","modified_gmt":"2018-10-20T16:40:04","slug":"une-cholestase-inexpliquee","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/une-cholestase-inexpliquee\/","title":{"rendered":"Une cholestase inexpliqu\u00e9e."},"content":{"rendered":"<p><strong>2012<\/strong><\/p>\n<p><em>S\u00e9verine HOMMEL, Magali PICON, Serge ERLINGER, Didier MATHIEU et Fran\u00e7ois CESSOT (Aix en provence)<\/em><\/p>\n<p><strong>H\u00e9patologie <\/strong>&#8211; \u00a02012-05-05 &#8211;\u00a0CO &#8211;<\/p>\n<p>________________________________<\/p>\n<p>Nous rapportons le cas d&rsquo;un patient ag\u00e9 de 55 ans adress\u00e9 pour bilan de cholestase ict\u00e9rique avec suspicion de n\u00e9oplasie de la t\u00eate du pancr\u00e9as.<br \/>\nLes sympt\u00f4mes apparus 3 semaines plus t\u00f4t consistent en un ict\u00e8re associ\u00e9 \u00e0 une alt\u00e9ration de l&rsquo;\u00e9tat g\u00e9n\u00e9ral (perte de 5 kg, anorexie, asth\u00e9nie).<br \/>\nLe bilan biologique demand\u00e9 par le m\u00e9decin traitant r\u00e9v\u00e8le une pancytop\u00e9nie (plaquettes \u00e0 96G\/l, Hb \u00e0 7.9 g\/dl, PNN \u00e0 2.2 G\/l), une insuffisance r\u00e9nale aigue avec cr\u00e9atinin\u00e9mie \u00e0 268 \u00b5mol\/l et une cholestase sans \u00e9l\u00e9vation des transaminases et avec TP normal(PAL \u00e0 825 UI\/l, GGT \u00e0 615 UI\/l, Bili T \u00e0 40 \u00b5mol\/l). L&rsquo;\u00e9chographie abdominale est sans particularit\u00e9 mais le scanner abdominal retrouve une hypodensit\u00e9 de la t\u00eate du pancr\u00e9as motivant la poursuite des explorations.<br \/>\nSes ant\u00e9c\u00e9dents sont marqu\u00e9s par un alcoolisme chronique \u00e0 120g\/j sevr\u00e9 depuis 1 an, une art\u00e9riopathie oblit\u00e9rante des MI (stents iliaques)et par un flutter r\u00e9cent r\u00e9duit par choc \u00e9lectrique externe. Son traitement comporte: TAHOR- HEMIGOXINE et BISOPROLOL.<br \/>\nL&rsquo;examen clinique met en \u00e9vidence une h\u00e9patom\u00e9galie, un ict\u00e8te et des oed\u00e8mes des MI.<br \/>\nLe bilan est compl\u00e9t\u00e9 par des s\u00e9rologies virales (VHB, VHC) n\u00e9gatives et par un bilan martial normal. Le scanner abdominopelvien inject\u00e9 puis la pancr\u00e9atowirsungoIRM ne r\u00e9v\u00e8lent anomalie pancr\u00e9atique mais la pr\u00e9sence d&rsquo;ad\u00e9nopathies centim\u00e9triques p\u00e9rih\u00e9patiques ainsi que d&rsquo;une h\u00e9patom\u00e9galie homog\u00e8ne. L&rsquo;\u00e9choendoscopie biliopancr\u00e9atique est normale. Le diagnostic de n\u00e9oplasie pancr\u00e9atique est donc \u00e9cart\u00e9.<br \/>\nDevant la pancytop\u00e9nie et la cholestase est \u00e9voqu\u00e9 le diagnostic d&rsquo;h\u00e9mopathie infirm\u00e9 par une immuno\u00e9lectrophor\u00e8se s\u00e9rique et urinaire normale, par des radiographies oseuses du corps entier normales puis par un my\u00e9logramme normal. Des BK tubages sont effectu\u00e9s, \u00e9liminant le diagnotic de tuberculose.<br \/>\nDevant la forte suspicion de cirrhose avec des r\u00e9sultats de Fibroscan en faveur (14 KPa)et malgr\u00e9 une FOGD normale et un bilan \u00e9tiologique exhaustif n\u00e9gatif (Alpha 1 AT, c\u00e9rul\u00e9oplasmine, cuprurie et Ac anti tissus), une PBH transpari\u00e9tale est effectu\u00e9e retrouvant un aspect d&rsquo;h\u00e9patite granulomateuse sans n\u00e9crose cas\u00e9euse avec \u00e9bauches de nodules. Le bilan est \u00e9tay\u00e9 par un dosage d&rsquo;angiotensine convertase revenant \u00e9lev\u00e9 \u00e0 147 UI\/l, par un scanner thoracique et des EFR s&rsquo;av\u00e9rant normaux. La bronchoscopie avec LBA ne montre qu&rsquo;une hyperlymphocytose. L&rsquo;examen ophtalmologique et l&rsquo;\u00e9chographie cardiaque sont sans particularit\u00e9. La biospie ost\u00e9om\u00e9dullaire objective des granulomes.<br \/>\nLe diagnostic retenu est donc celui de sarcoidose avec atteinte m\u00e9dullaire, h\u00e9patique (pr\u00e9cirrhog\u00e8ne ou cirrhog\u00e8ne), r\u00e9nale (n\u00e9phrite interstitielle)et possiblement cardiaque.<br \/>\nUne corticoth\u00e9rapie \u00e0 0.5 mg\/kg est instaur\u00e9e rapidement permettant en 2 mois une nette r\u00e9gression de la cholestase, une quasi correction de la fonction r\u00e9nale et de la pancytop\u00e9nie. Une d\u00e9croissance de la corticoth\u00e9rapie est actuellement en cours.<br \/>\nLe diagnotic de sarcoidose d&rsquo;\u00e9volution cirrhog\u00e8ne est rare, il faut savoir cependant l&rsquo;\u00e9voquer devant des formes cholestatiques inexpliqu\u00e9es.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>2012 S\u00e9verine HOMMEL, Magali PICON, Serge ERLINGER, Didier MATHIEU et Fran\u00e7ois CESSOT (Aix en provence) H\u00e9patologie &#8211; \u00a02012-05-05 &#8211;\u00a0CO &#8211; ________________________________ Nous rapportons le cas d&rsquo;un patient ag\u00e9 de 55 ans adress\u00e9 pour bilan de cholestase ict\u00e9rique avec suspicion de n\u00e9oplasie de la t\u00eate du pancr\u00e9as. Les sympt\u00f4mes apparus 3 semaines plus t\u00f4t consistent en [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[3],"tags":[23],"class_list":["post-1950","post","type-post","status-publish","format-standard","hentry","category-hepatologie","tag-23"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.2 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Une cholestase inexpliqu\u00e9e. - Abstracts des congr\u00e8s de l&#039;ANGH<\/title>\n<meta name=\"description\" content=\"ANGH R\u00e9sum\u00e9s congr\u00e8s H\u00e9patologie Gastroent\u00e9romogie Hepatology Gastroenterology Etudes cliniques Clinical study\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/angh.net\/abstracts\/une-cholestase-inexpliquee\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Une cholestase inexpliqu\u00e9e. - 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