{"id":2047,"date":"2016-10-01T01:00:00","date_gmt":"2016-10-01T00:00:00","guid":{"rendered":"https:\/\/angh.net\/abstracts\/un-ictere-atypique\/"},"modified":"2018-10-20T18:40:22","modified_gmt":"2018-10-20T16:40:22","slug":"un-ictere-atypique","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/un-ictere-atypique\/","title":{"rendered":"Un ict\u00e8re atypique"},"content":{"rendered":"<p><strong>2016<\/strong><\/p>\n<p><em>P. Keriel, S.Hommel, M.Picon, MC. Charton Bain, S. Erlinger<\/em><\/p>\n<p><strong>H\u00e9patologie <\/strong>&#8211; \u00a02016-04-30 &#8211;\u00a0 &#8211;<\/p>\n<p>________________________________<\/p>\n<p>Nous rapportons le cas d&rsquo;un jeune homme \u00e2g\u00e9 de 25 ans hospitalis\u00e9 dans notre service en 07\/2015 pour bilan d&rsquo;un ict\u00e8re associ\u00e9 \u00e0 une AEG.<br \/>\nCe patient sans ant\u00e9c\u00e9dent particulier, a \u00e9t\u00e9 admis en gastroent\u00e9rologie pour un ict\u00e8re apparu depuis 1 semaine avec urines fonc\u00e9es, selles d\u00e9color\u00e9es sans douleurs abdominales ni fi\u00e8vre associ\u00e9es mais s&rsquo;accompagnant d&rsquo;une asth\u00e9nie marqu\u00e9e.<br \/>\nOn ne notait \u00e0 l&rsquo;interrogatoire aucun voyage r\u00e9cent \u00e0 l&rsquo;\u00e9tranger, aucune prise m\u00e9dicamenteuse,  aucune consommation de charcuterie ou fruits de mer. Le patient avouait ne consommer que rarement de l&rsquo;alcool et ce de mani\u00e8re festive.<br \/>\nLe patient ne rapportait aucun ant\u00e9c\u00e9dent familial particulier.<br \/>\nL&rsquo;examen clinique \u00e9tait sans particularit\u00e9.<br \/>\nLe bilan biologique initial retrouvait: BIli T \u00e0 593 micromol\/l dont 344 de conjugu\u00e9e, TGO \u00e0 1076, TGP 675 et GGT \u00e0 156 UI\/L. LEs PAL et le TP \u00e9taient normaux.<br \/>\nLes s\u00e9rologies virales A,B,C,D,E effectu\u00e9es dans un 1\u00b0 temps revenaient n\u00e9gatives. L&rsquo;\u00e9chographie abdominale ne confirmait aucun obstacle et le scanner TAP ne retrouvait comme seule anomalie une h\u00e9patom\u00e9galie. Les veines sus h\u00e9patiques \u00e9taient perm\u00e9ables. La cholangio IRM \u00e9tait normale.<br \/>\nLe bilan \u00e9tait compl\u00e9t\u00e9 par les s\u00e9rologies EBV, CMV, toxoplamose, Leptospirose, Coxiella n\u00e9gatives puis par un bilan autoimmun ( FAN, A anti LKM1, muscle lisse et mitochondrie) \u00e9galement n\u00e9gatif. La recherche d&rsquo;h\u00e9molyse revenait n\u00e9gative elle aussi.<br \/>\nDevant l&rsquo;aggravation du bilan h\u00e9patique, \u00e9tait d\u00e9cid\u00e9e une PBH retrouvant une h\u00e9patite aigue sans st\u00e9atose avec n\u00e9crose centrolobulaire, sans cirrhose.<br \/>\nDevant l&rsquo;absence d&rsquo;\u00e9tiologie, un dosage de c\u00e9rul\u00e9oplasmine puis cuprurie \u00e9tait prescrit confirmant une \u00e9l\u00e9vation significative de la cuprurie \u00e0 163 microg\/l (&gt; 0.20). L&rsquo;examen \u00e0 la lampe \u00e0 fente ne retrouvait pas d&rsquo;anneau de Kaiser Fleischer.<br \/>\nEtait alors propos\u00e9 pour avancer dans ce diagnostic une 2\u00b0 PBH avec quantification de la concentration h\u00e9patique en cuivre confirmant une surcharge en cuivre avec dosage \u00e0 38.6 &gt; 20.<br \/>\nLe diagnostic de Maladie de Wilson \u00e9tait retenu et un traitement rapide par TROLOVOL d\u00e9cid\u00e9. Malheureusement, le patient est sorti contre avis m\u00e9dical. La suite dela prise en charge a \u00e9t\u00e9 assur\u00e9e par le CHU de Montpelier.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>2016 P. Keriel, S.Hommel, M.Picon, MC. Charton Bain, S. Erlinger H\u00e9patologie &#8211; \u00a02016-04-30 &#8211;\u00a0 &#8211; ________________________________ Nous rapportons le cas d&rsquo;un jeune homme \u00e2g\u00e9 de 25 ans hospitalis\u00e9 dans notre service en 07\/2015 pour bilan d&rsquo;un ict\u00e8re associ\u00e9 \u00e0 une AEG. Ce patient sans ant\u00e9c\u00e9dent particulier, a \u00e9t\u00e9 admis en gastroent\u00e9rologie pour un ict\u00e8re apparu [&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":[27],"class_list":["post-2047","post","type-post","status-publish","format-standard","hentry","category-hepatologie","tag-27"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.2 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Un ict\u00e8re atypique - 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\/un-ictere-atypique\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Un ict\u00e8re atypique - 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