{"id":2010,"date":"2014-10-01T01:00:00","date_gmt":"2014-10-01T00:00:00","guid":{"rendered":"https:\/\/angh.net\/abstracts\/une-hepatite-e-aggravant-une-cirrhose-nash-et-persistante-plus-de-6-mois-en-labsence-dimmunosupression\/"},"modified":"2018-10-20T18:40:15","modified_gmt":"2018-10-20T16:40:15","slug":"une-hepatite-e-aggravant-une-cirrhose-nash-et-persistante-plus-de-6-mois-en-labsence-dimmunosupression","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/une-hepatite-e-aggravant-une-cirrhose-nash-et-persistante-plus-de-6-mois-en-labsence-dimmunosupression\/","title":{"rendered":"Une h\u00e9patite E aggravant une cirrhose NASH et persistante plus de 6 mois en l\u2019absence d’immunosupression."},"content":{"rendered":"

2014<\/strong><\/p>\n

Petitdidier N, Condat B, Zanditenas D, Bonnet J, Ould-Ahmed B, Ngo Y, Blazquez M
\nService d\u2019h\u00e9pato-gastro-ent\u00e9rologie de l\u2019h\u00f4pital Saint-Camille, Bry-Sur-Marne, 94.<\/em><\/p>\n

H\u00e9patologie <\/strong>– \u00a02014-05-05 –\u00a0CC –<\/p>\n

________________________________<\/p>\n

Il est observ\u00e9 une franche augmentation du nombre de cas autochtones d\u2019h\u00e9patite virale E dans les pays occidentaux surtout apr\u00e8s ingestion de viandes porcines contamin\u00e9es. Nous rapportons le cas d’un patient atteint d\u2019h\u00e9patite E aig\u00fce aggravant une cirrhose NASH exceptionnel par le passage \u00e0 la chronicit\u00e9 en l\u2019absence de toute immunosupression.
\nCas clinique :
\nUn homme de 61 ans, ne consommant pas d\u2019alcool, ayant pour ant\u00e9c\u00e9dents un syndrome m\u00e9tabolique (diab\u00e8te de type 2, dyslip\u00e9mie et IMC \u00e0 30) et une cardiopathie isch\u00e9mique fut hospitalis\u00e9 le 15 Juillet 2012 pour un ict\u00e8re depuis une semaine et une asth\u00e9nie intense depuis d\u00e9but Juin 2012. Le bilan biologique montrait des ALAT \u00e0 15 N, des ASAT \u00e0 12 N, des GGT \u00e0 10 N, des PAL normales, une bilirubine totale \u00e0 55 micromol\/L, une NFS normale et un TP normal. Le patient avait pris fin Juin 2012, dans un contexte de syndrome pseudo grippal sans sepsis av\u00e9r\u00e9, un traitement par Augmentin per os pendant une semaine. Il n\u2019\u00e9tait pas rapport\u00e9 d\u2019autres traitements r\u00e9cemment institu\u00e9s. L\u2019IgM VHA, l\u2019Ag HBs, l\u2019AC HCV et les s\u00e9rologies EBV et CMV ne mettaient pas en \u00e9vidence d\u2019argument pour une infection virale aig\u00fce. Les anticorps anti tissus \u00e9taient n\u00e9gatifs. Le bilan du cuivre \u00e9tait normal. Le bilan morphologique (\u00e9chographie et IRM) mettait en \u00e9vidence un foie st\u00e9atosique et dysmorphique et une spl\u00e9nom\u00e9galie sans autre anomalie. La FOGD mettait en \u00e9vidence une gastrite fundique en mosa\u00efque intense \u00e9vocatrice de gastrite d\u2019hypertension portale. Le diagnostic initialement \u00e9voqu\u00e9 \u00e9tait celui d\u2019h\u00e9patite m\u00e9dicamenteuse due \u00e0 l\u2019Augmentin chez un patient atteint de cirrhose NASH non compliqu\u00e9e.
\nLa cytolyse h\u00e9patique persistait par la suite avec une augmentation prolong\u00e9e des ALAT \u00e0 5 N et en Octobre 2012 le patient \u00e9tait r\u00e9admis pour persistance de l\u2019asth\u00e9nie intense, de l\u2019ict\u00e8re et apparition d\u2019une ascite radiologique. Le diagnostic d\u2019h\u00e9patite E aig\u00fce (IgM et IgG VHE positifs, vir\u00e9mie positive) de g\u00e9notype 3 \u00e9tait alors port\u00e9. Un traitement par ribavirine \u00e9tait d\u00e9but\u00e9 le 12 Octobre 2012 \u00e0 la dose quotidienne initiale de 600 mg.
\nUn mois apr\u00e8s le d\u00e9but du traitement les transaminases \u00e9taient redevenues normales, l\u2019ict\u00e8re et l\u2019asth\u00e9nie avaient disparu et l\u2019ascite \u00e9tait ass\u00e9ch\u00e9e sous diur\u00e9tiques. Par contre, la persistance de la vir\u00e9mie plus de 6 mois apr\u00e8s le diagnostic faisait porter le diagnostic d\u2019h\u00e9patite E chronique. Un bilan exhaustif \u00e0 la recherche de cause d\u2019immunod\u00e9pression \u00e9tait n\u00e9gatif. L\u2019augmentation des doses de ribavirine \u00e0 800mg \u00e0 partir de Septembre 2013 \u00e9tait associ\u00e9e \u00e0 la n\u00e9gativation persistante de la vir\u00e9mie \u00e0 partir d’Octobre 2013.
\nLe diagnostic final retenu \u00e9tait celui d\u2019h\u00e9patite virale aig\u00fce E aggravant une cirrhose NASH et passant \u00e0 la chronicit\u00e9 chez un sujet immunocomp\u00e9tent.
\nDiscussion :
\nLa recherche d\u2019une h\u00e9patite E devrait devenir syst\u00e9matique en cas d\u2019aggravation aig\u00fce d\u2019une h\u00e9patopathie chronique et devant toute h\u00e9patite aig\u00fce cytolytique. L\u2019h\u00e9patite E chronique a \u00e9t\u00e9 fr\u00e9quemment rapport\u00e9e chez des patients immunod\u00e9prim\u00e9s (transplant\u00e9s, h\u00e9mopathies malignes, s\u00e9ropositifs pour le VIH). Sa survenue, comme pour notre patient, chez un sujet immunocomp\u00e9tent est extr\u00eamement rare, un seul cas a \u00e9t\u00e9 rapport\u00e9*. L\u2019augmentation rapide des cas d\u2019h\u00e9patite E en France pourrait \u00eatre associ\u00e9 \u00e0 la mise en \u00e9vidence de passages \u00e0 la chronicit\u00e9 moins exceptionnels chez les patients immunocomp\u00e9tents.
\n*Grewal P et al. Hepatology 2014.<\/p>\n","protected":false},"excerpt":{"rendered":"

2014 Petitdidier N, Condat B, Zanditenas D, Bonnet J, Ould-Ahmed B, Ngo Y, Blazquez M Service d\u2019h\u00e9pato-gastro-ent\u00e9rologie de l\u2019h\u00f4pital Saint-Camille, Bry-Sur-Marne, 94. H\u00e9patologie – \u00a02014-05-05 –\u00a0CC – ________________________________ Il est observ\u00e9 une franche augmentation du nombre de cas autochtones d\u2019h\u00e9patite virale E dans les pays occidentaux surtout apr\u00e8s ingestion de viandes porcines contamin\u00e9es. Nous rapportons […]<\/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":[25],"class_list":["post-2010","post","type-post","status-publish","format-standard","hentry","category-hepatologie","tag-25"],"yoast_head":"\nUne h\u00e9patite E aggravant une cirrhose NASH et persistante plus de 6 mois en l\u2019absence d'immunosupression. - Abstracts des congr\u00e8s de l'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-e-aggravant-une-cirrhose-nash-et-persistante-plus-de-6-mois-en-labsence-dimmunosupression\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Une h\u00e9patite E aggravant une cirrhose NASH et persistante plus de 6 mois en l\u2019absence d'immunosupression. - 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