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Dig Dis Sci (2007) 52:26292632 DOI 10.1007/s10620-006-9405-9
Necrotizing Granulomatous Hepatitis as an Unusual Manifestation of Lyme Disease
Antonela C. Zanchi Alan R. Gingold Neil D. Theise Albert D. Min
Received: 22 March 2006 / Accepted: 23 April 2006 / Published online: 20 July 2007
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Springer Science+Business Media, Inc. 2007
Keywords Liver disease . Hepatitis . Lyme disease .
Necrotizing granulomas . Pathology
Introduction
Lyme disease is the most common vector-borne infection in the United States and is caused by Borrelia burgdorferi, a spirochete that is transmitted from the ixodid tick. Abnormal liver chemistry is a rare, but well-described phenomenon in Lyme disease infection [1]. There have been several postulated theories as to the cause of hepatitis withB. burgdorferi infection. These include direct toxicity from the spirochete, systemic cytokine release, and, possibly, an immune-mediated event [2]. Although elevated aminotransferase has been seen, there has been only one case reported of granulomatous hepatitis from Lyme infection [3]. We describe here the rst case of a patient with acute Lyme disease who was found to have necrotizing granulomatous hepatitis with eosinophilic inltration of the liver.
A. C. Zanchi N. D. Theise Division of Digestive Diseases, Department of Pathology, Beth Israel Medical Center,New York, New York 10013, USA
A. R. Gingold N. D. Theise A. D. Min ([envelopeback])
Division of Digestive Diseases, Department of Medicine, Beth Israel Medical Center,First Avenue at 16th Street, New York, New York 10003, USA e-mail: [email protected]
Case report
A 22-year-old African-American female presented to her primary care physician with the abrupt onset of lower back and epigastric pain, accompanied by fever and chills. These were worse in the evening. A chest x-ray was negative and the initial laboratory results revealed a mild increase in aminotransferase levels. The patient was diagnosed with viral syndrome and was treated symptomatically with ibuprofen for pain and fever.
Her symptoms persisted, and the patient made two subsequent visits to the emergency room of her local hospital. She was prescribed trimethoprim/sulfamethoxazole for presumed urinary tract infection at the rst emergency room visit, and she was given ciprooxacin for possible pyelonephritis during her second visit. Several days after her second visit to the emergency room, the patient was admitted to another hospital for persistent fever and body aches. The...