{"id":1953,"date":"2012-10-01T01:00:00","date_gmt":"2012-10-01T00:00:00","guid":{"rendered":"https:\/\/angh.net\/abstracts\/une-hepatite-aigue-a-foie-normal\/"},"modified":"2018-10-20T18:40:04","modified_gmt":"2018-10-20T16:40:04","slug":"une-hepatite-aigue-a-foie-normal","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/une-hepatite-aigue-a-foie-normal\/","title":{"rendered":"UNE HEPATITE AIGUE A FOIE NORMAL\u2026"},"content":{"rendered":"<p><strong>2012<\/strong><\/p>\n<p><em>Cl\u00e9mence Hollande, Isabelle Rosa, Camille Barrault, Sandrine Barge, Laurent Costes, Thierry Lons, Herv\u00e9 Hag\u00e8ge ; Service d\u2019h\u00e9pato-gastroent\u00e9rologie, Centre Hospitalier Intercommunal de Cr\u00e9teil<\/em><\/p>\n<p><strong>H\u00e9patologie <\/strong>&#8211; \u00a02012-05-07 &#8211;\u00a0CO &#8211;<\/p>\n<p>________________________________<\/p>\n<p>Une jeune femme de 18 ans consulte pour cytolyse h\u00e9patique \u00e0 7N d\u00e9couverte au cours d\u2019un bilan d\u2019exploration d\u2019arthralgies. Les ASAT sont \u00e0 214 (N&lt;30), les ALAT \u00e0 185 (N&lt;35), la phosphatase alcaline est normale et la Gamma GT est \u00e0 2N, la bilirubine est normale. L\u2019albumin\u00e9mie est \u00e0 40 g\/l, les plaquettes \u00e0 271 000 et le TP \u00e0 73 % avec un facteur V \u00e0 87 %.<br \/>\nL\u2019\u00e9chographie h\u00e9patique montre une discr\u00e8te h\u00e9patom\u00e9galie homog\u00e8ne sans nodule ni signe d\u2019hypertension portale. Une \u00e9tiologie virale est \u00e9limin\u00e9e avec s\u00e9rologies de l\u2019h\u00e9patite A, B, C, E n\u00e9gatives. Les s\u00e9rologies CMV et EBV sont en faveur d\u2019une infection ancienne. La ferritine est \u00e0 20 ng\/ml. La patiente n\u2019est pas en surpoids. Il n\u2019y a pas d\u2019argument  en faveur d\u2019une st\u00e9atopathie m\u00e9tabolique.<br \/>\nEn revanche, le bilan auto-immun retrouve des anticorps anti-nucl\u00e9aires totaux \u00e0 1\/160\u00e8me d\u2019aspect mouchet\u00e9 mais avec des anti-muscle lisse, anti-mitochondries, anti-LKM1 et anti-cytosol n\u00e9gatifs. Il existe une hypergammaglobulin\u00e9mie avec des IgG \u00e0 24,4 g\/l.<br \/>\nDevant l\u2019aggravation du bilan h\u00e9patique avec une cytolyse \u00e0 500, une biopsie h\u00e9patique est r\u00e9alis\u00e9e. L\u2019histologie conclut \u00e0 un parenchyme h\u00e9patique normal en dehors d\u2019un discret infiltrat inflammatoire portal.<br \/>\nFinalement, le bilan \u00e9tiologique met en \u00e9vidence des anticorps anti-transglutaminase tr\u00e8s positifs sup\u00e9rieurs \u00e0 300 unit\u00e9s, confirm\u00e9s par des anticorps anti-endomysium positifs \u00e0 1\/180. Une endoscopie digestive haute a permis de r\u00e9aliser des biopsies duod\u00e9nales retrouvant un aspect d\u2019atrophie villositaire subtotale.<br \/>\nLe diagnostic de maladie coeliaque avec manifestations h\u00e9patiques et articulaires est donc port\u00e9 et le r\u00e9gime sans gluten a donc \u00e9t\u00e9 d\u00e9but\u00e9. Apr\u00e8s 9 mois de r\u00e9gime sans gluten, il existe une am\u00e9lioration lente de la cytolyse avec des ASAT \u00e0 97 et des ALAT \u00e0 85.<br \/>\nLes perturbations du bilan h\u00e9patique au cours d\u2019une maladie coeliaque sont rares mais d\u00e9crites, elles surviennent g\u00e9n\u00e9ralement au cours de maladies coeliaques diagnostiqu\u00e9es. La pr\u00e9sentation h\u00e9patique mimant une h\u00e9patite auto-immune est plus exceptionnelle. N\u00e9anmoins, il faut savoir \u00e9voquer ce diagnostic y compris lorsqu\u2019il existe un tableau d\u2019h\u00e9patite auto-immune et proposer le dosage des anticorps anti transglutaminases dans le bilan \u00e9tiologique avant de r\u00e9aliser la biopsie.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>2012 Cl\u00e9mence Hollande, Isabelle Rosa, Camille Barrault, Sandrine Barge, Laurent Costes, Thierry Lons, Herv\u00e9 Hag\u00e8ge ; Service d\u2019h\u00e9pato-gastroent\u00e9rologie, Centre Hospitalier Intercommunal de Cr\u00e9teil H\u00e9patologie &#8211; \u00a02012-05-07 &#8211;\u00a0CO &#8211; ________________________________ Une jeune femme de 18 ans consulte pour cytolyse h\u00e9patique \u00e0 7N d\u00e9couverte au cours d\u2019un bilan d\u2019exploration d\u2019arthralgies. Les ASAT sont \u00e0 214 (N&lt;30), les [&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-1953","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 HEPATITE AIGUE A FOIE NORMAL\u2026 - 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-hepatite-aigue-a-foie-normal\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"UNE HEPATITE AIGUE A FOIE NORMAL\u2026 - 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