PMC3894917_01
Clinical and biological course of L-asparaginase associated steatohepatitis. L-asparaginase (*) was prescribed from J8 (first injection) to J26 (6th and last injection). The patients experienced fever and biological inflammatory syndrome after neutrophils recovery from J22 to J37 (Grey zone). Atovaquone and corticosteroids for Pneumocystis treatment was started at J36. gammaGT - gamma-glutamyltransferase.
amjcaserep-15-13-g001.jpg
PMC3894917_01_amjcaserep-15-13-g001.jpg
f1-amjcaserep-15-13
While recovering neutrophils on day 22, he experienced fever again and an increase of biological inflammatory markers (grey zone, Figure 1).
(A) Computed tomography revealed hepatomegaly (*=hepatic arrow 22.2 cm) with major homogeneous steatosis. (B) Liver biopsy showed a diffuse lobular steatosis >50% of hepatocytes, with moderate hepatocyte necrosis, and mild inflammatory lobular and portal infiltration (HE x10).
amjcaserep-15-13-g002.jpg
PMC3894917_01_amjcaserep-15-13-g002.jpg
f2-amjcaserep-15-13
At that time, bone marrow aspirate showed achievement of complete remission. A large and systematic diagnosis strategy, including screening for viral infections (HBV, HCV, HAV, HEV, VZV, EBV, HSV, CMV, HIV, PVB19), and autoantibodies (anti nuclear, anti-neutrophil cytoplasmic, anti-mitochondria, anti-actin, anti-endoplasmic reticulum, anti-LKM1, and anti-GP210), was negative. Lipid profile only revealed an isolated hypertriglyceridemia (3.3 g/l). A second abdominal echography, and contrast computed tomography were performed, this time showing homogeneous hepatomegaly (hepatic arrow at 22.2 cm) with signs of major steatosis (Cf Figure 2A), and no sign of biliary obstruction or vascular abnormality. Pathology examination revealed macro- and microvesicular severe steatosis, affecting more than 50% of hepatocytes, with a moderate hepatocyte necrosis, and a mild portal and lobular inflammatory infiltration, including rare neutrophils (Figure 2B).