{"id":2291,"date":"2019-12-31T19:32:06","date_gmt":"2019-12-31T18:32:06","guid":{"rendered":"https:\/\/angh.net\/abstracts\/une-hepatite-a-qui-rechute\/"},"modified":"2019-12-31T19:32:06","modified_gmt":"2019-12-31T18:32:06","slug":"une-hepatite-a-qui-rechute","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/une-hepatite-a-qui-rechute\/","title":{"rendered":"Une h\u00e9patite A qui rechute ?"},"content":{"rendered":"<p><strong>2019<\/strong><\/p>\n<p><em>Ratmony Heng1, Armand Garioud1, Camelia Mokhtari2, Honor\u00e9 Zougmor\u00e91, Mourad Medmoun1, Philippe Pulvermacher1, Allaoua Sma\u00efl3, Alain Cazier4, Jean-Francois Cadranel1.<\/p>\n<p>1. Service d\u2019h\u00e9pato-gastroent\u00e9rologie d\u2019Alcoologie et nutrition \u2013 GHPSO \u2013 Creil (60)<br \/>\n2. Service de biologie m\u00e9dicale \u2013 GHPSO \u2013 Creil (60)<br \/>\n3. Service de chirurgie digestive \u2013 GHPSO \u2013 Creil (60)<br \/>\n4. Service d\u2019anatomopathologie \u2013 GHPSO \u2013 Creil (60)<\/em><\/p>\n<p><strong>H\u00e9patologie <\/strong>&#8211; \u00a02019-05-11 &#8211;\u00a0CC &#8211;<\/p>\n<p>________________________________<\/p>\n<p>Mme B., une femme de 57 ans a \u00e9t\u00e9 transf\u00e9r\u00e9e fin avril 2018 du service de cardiologie dans le service d\u2019h\u00e9pato-gastroent\u00e9rologie pour l\u2019exploration d\u2019un ict\u00e8re cutan\u00e9o-muqueux de survenue r\u00e9cente. Elle avait initialement \u00e9t\u00e9 admise pour une coronographie de contr\u00f4le du fait d\u2019un ant\u00e9c\u00e9dent d\u2019infarctus du myocarde, associ\u00e9 \u00e0 une dyslipid\u00e9mie et un tabagisme. Son traitement \u00e0 l&rsquo;admission comprenait pantoprazole, ticagr\u00e9lor, acide ac\u00e9tylsalicylique, bisoprolol, atorvastatine et \u00e9noxaparine, aucun autre m\u00e9dicament notamment h\u00e9patotoxique n\u2019ayant \u00e9t\u00e9 introduit au cours des douze derniers mois.<br \/>\n\u00c0 son admission, les signes associ\u00e9s \u00e9taient des douleurs abdominales notamment au niveau de l\u2019hypochondre droit, une asth\u00e9nie, des vomissements et des douleurs musculaires. Sur la biologie, les leucocytes \u00e9taient \u00e0 6.360\/mm3 avec 34% de polynucl\u00e9aires neutrophiles et 51% de lymphocytes, le taux d&rsquo;h\u00e9moglobine \u00e9tait de 13,9 g\/dl et le nombre de plaquettes de 273.000\/mm3. La biochimie h\u00e9patique \u00e9tait la suivante: ASAT \u00e0 3795 UI\/L (n<35), ALAT \u00e0 3351 UI\/L (n<35), PAL \u00e0 260 UI\/L (n<105), GGT \u00e0 102 UI\/L (n<42) avec une bilirubin\u00e9mie totale \u00e0 49 \u00b5mol\/l (n<15) dont 41,2 \u00b5mol\/l de bilirubine conjugu\u00e9e (n<5). Le TP \u00e9tait \u00e0 78%. L'\u00e9chographie h\u00e9patique \u00e9tait normale ne mettant pas en \u00e9vidence de dilatation des voies biliaires intra ou extra-h\u00e9patiques avec une v\u00e9sicule biliaire alithiasique et un foie de morphologie normale.\nCliniquement, la patiente mesurait 167 cm pour un poids de 60 kg (IMC \u00e0 22kg\/m2). Elle n'avait aucun ant\u00e9c\u00e9dent de consommation d'alcool ou de toxicomanie. Concernant le bilan \u00e9tiologique, les s\u00e9rologies des h\u00e9patites B (AgHBs, IgM-HBc), C (Ac), E (IgM), CMV (IgG) et EBV (IgM) et VIH 1-2 (Ac) \u00e9taient n\u00e9gatives. En revanche, la s\u00e9rologie pour l\u2019h\u00e9patite A \u00e9tait positive avec un taux d\u2019Ig totales \u00e0 59,5 UI\/ml et des IgM positifs \u00e0 11,11 UI\/ml \u00e9tablissant le diagnostic d'h\u00e9patite aigu\u00eb A avec une charge virale VHA \u00e0 1.193.980 UI\/ml (6,08 log). Les IgG \u00e9taient subnormales \u00e0 13,6 g\/l (n<12,6) et la recherche des anticorps antinucl\u00e9aires et anti-SMA, LKM1, LC1, SLA et M2\/nPDC \u00e9tait n\u00e9gative.\nApr\u00e8s une diminution spontan\u00e9e de la cytolyse h\u00e9patique et de la bilirubin\u00e9mie, la patiente est r\u00e9hospitalis\u00e9e mi-juin 2018 en raison d\u2019une asth\u00e9nie associ\u00e9e \u00e0 la r\u00e9apparition d\u2019un ict\u00e8re flamboyant. Sur la biologie, les ASAT \u00e9taient \u00e0 2234 UI\/ml, les ALAT \u00e0 1884 UI\/l et la bilirubin\u00e9mie totale \u00e0 299,1 \u00b5mol\/L \u00e0 nette pr\u00e9dominance conjugu\u00e9e. Elle n\u2019a pas pris de nouveau m\u00e9dicament, n\u2019a pas voyag\u00e9 dans l\u2019intervalle. Une \u00e9chographie h\u00e9patique a \u00e9t\u00e9 refaite. Elle \u00e9tait normale. Les IgM VHA \u00e9taient toujours positifs \u00e0 1,8 UI\/ml avec une charge virale A \u00e0 840 UI\/ml (2.92 log).\n\nA quoi pensez-vous ? S\u2019agirait-il d\u2019une rechute de l\u2019h\u00e9patite A ?\nQuels examens faites-vous pour avancer dans le diagnostic ? \nLes r\u00e9ponses et la suite de l\u2019\u00e9volution vous seront donn\u00e9es lors du congr\u00e8s.\n<\/p>\n","protected":false},"excerpt":{"rendered":"<p>2019 Ratmony Heng1, Armand Garioud1, Camelia Mokhtari2, Honor\u00e9 Zougmor\u00e91, Mourad Medmoun1, Philippe Pulvermacher1, Allaoua Sma\u00efl3, Alain Cazier4, Jean-Francois Cadranel1. 1. Service d\u2019h\u00e9pato-gastroent\u00e9rologie d\u2019Alcoologie et nutrition \u2013 GHPSO \u2013 Creil (60) 2. Service de biologie m\u00e9dicale \u2013 GHPSO \u2013 Creil (60) 3. Service de chirurgie digestive \u2013 GHPSO \u2013 Creil (60) 4. Service d\u2019anatomopathologie \u2013 GHPSO [&hellip;]<\/p>\n","protected":false},"author":1,"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":[30],"class_list":["post-2291","post","type-post","status-publish","format-standard","hentry","category-hepatologie","tag-30"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.2 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Une h\u00e9patite A qui rechute ? - 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-a-qui-rechute\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Une h\u00e9patite A qui rechute ? 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