Gebeliğin intrahepatik kolestazı ve hepatit B reaktivasyonu: Olgu sunumu

Gebeliğin intrahepatik kolestazı ve hepatit B reaktivasyonu birlikteliği literatürde bildirilmemiş, nadir görülebilecek bir durumdur. Burada her iki durumun eşzamanlı görüldüğü bir olgu sunulmuştur. 30 yaşında 30 haftalık gebe kaşıntı nedeniyle başvurdu. 4 yıldır inaktif hepatit B nedeniyle izlemde olan hastanın laboratuvar ve ultrasonografisi incelemesinde hepatit b reaktivasyonu ile birlikte gebeliğin intrahepatik kolestazı düşünüldü. Lamivudin ve ursodeoksikolik asit başlandı. Tedavi ile hastanın transaminazları geriledi. Kaşıntısı düzeldi. Gebeliğin 37. haftasında sezeryanla sağlıklı bir doğum geçekleşti. Hastanın doğum sonrası ursodeoksikolikasit ve lamivudin tedavisi kesildi. Bu hastada ursodeoksikolikasit ve lamivudinin birlikte kullanımı etkili olmuştur. Burada bebeğin matürasyonunun oluşması için geçecek süre ve bu süre içinde annede fulminan hepatit gelişme riski önem taşımaktadır.

Anahtar Kelimeler:

Gebelik, kolestaz, hepatit B virüsü

Intrahepatic cholestasis of pregnancy plus reactivation of hepatitis B: Case report

Intrahepatic cholestasis of pregnancy with reactivation of hepatitis B is a rare condition. In this manuscript, we present a case with concomitant presentation of these two pathologies. A 30-yearold, 30-week pregnant woman presented with the complaint of itching. The patient had been followed for inactive hepatitis B for four years. Laboratory tests and abdominal ultrasonography suggested reactivation of hepatitis B in addition to İntrahepatic cholestasis of pregnancy. Treatment with lamivudine and ursodeoxycholic acid was initiated. The transaminases levels and complaint of itching improved with treatment. A healthy delivery was performed by cesarean section at 37 weeks of gestation. The ursodeoxycholic acid and lamivudine therapies were discontinued post-partum. Concomitant use of ursodeoxycholic acid and lamivudine was effective in this case. The time needed for the maturation of the infant and the risk of fulminant hepatitis were the important points considered in this case.

Keywords:

Pregnancy, cholestasis, hepatitis B virus,

PDF

___

Lammert F, Marschall HU, Glantz A, Matern S. Intrahepatic cho- lestasis of pregnancy: molecular pathogenesis, diagnosis and man- agement. J Hepatol 2000; 33:1012-21.
Beuers U, Pusl T. Intrahepatic cholestasis of pregnancy--a hetero- geneous group of pregnancy-related disorders? Hepatology 2006; 43:647-9.
Germain AM, Carvajal JA, Glasinovic JC, et al. Intrahepatic cholesta- sis of pregnancy: an intriguing pregnancy-specific disorder. J Soc Gynecol Investig 2002; 9:10-4.
Reyes H, Gonzalez MC, Ribalta J, et al. Prevalence of intrahepatic cholestasis of pregnancy in Chile. Ann Intern Med 1978; 88:487- 93.
Reyes H, Taboada G, Ribalta J. Prevalence of intrahepatic cholesta- sis of pregnancy in La Paz, Bolivia. J Chronic Dis 1979; 32:499-504.
Milkiewicz P, Elias E, Williamson C, Weaver J. Obstetric cholestasis: May have serious consequences for the fetus, and needs to be taken seriously. BMJ 2002; 324:123-4.
Fam Physician 2007; 75:211-8.
Williamson C, Gorelik J, Eaton BM, et al. The bile acid taurocho- late impairs rat cardiomyocyte function: a proposed mechanism for intra-uterine fetal death in obstetric cholestasis. Clin Sci (Lond) 2001; 100:363-9.
Bacq Y, Sapey T, Brechot MC, et al. Intrahepatic cholestasis of pregnancy: a French prospective study. Hepatology 1997; 26:358- 64.
Knox TA, Olans LB. Liver disease in pregnancy. N Engl J Med 1996; 335:569-76.
Rolfes DB, Ishak KG. Liver disease in pregnancy. Histopathology 1986; 10:555-70.
Glantz A, Marschall HU, Lammert F, Mattsson LA. Intrahepatic cholestasis of pregnancy: a randomized controlled trial compar- ing dexamethasone and ursodeoxycholic acid. Hepatology 200; 42:1399-405.
Kondrackiene J, Beuers U, Kupcinskas L. Efficacy and safety of ur- sodeoxycholic acid versus cholestyramine in intrahepaticcholestasis of pregnancy. Gastroenterology 2005; 129:894-901.
Lavanchy D. Hepatitis B virus epidemiology, disease burden, treat- ment, and current and emerging prevention and control measures. J Viral Hepat 2004; 11:97-107.
Chen CJ, Wang LY, Yu MW. Towards control of hepatitis B in the Asia-Pacific region. Epidemiology of hepatitis B virus infection in the Asia-Pacific region. J Gastroenterol Hepatol 2000; 15(Suppl):E3-6.
Lok AS. Chronic hepatitis B. N Engl J Med 2002; 346:1682-3.
Yao JL. Perinatal transmission of hepatitis B virus infection and vac- cination in China. Gut 1996; 38 (Suppl 2):S37-8.
Ngui SL, Andrews NJ, Underhill GS, et al. Failed postnatal immuno- prophylaxis for hepatitis B: characteristics of maternal hepatitis B virus as risk factors. Clin Infect Dis 1998; 27:100-6.
Del Canho R, Grosheide PM, Mazel JA, et al. Ten-year neonatal hepatitis vaccination program, The Netherlands, 1982-1992: pro- tective efficacy and long-term immunogenicity. Vaccine 1997; 15:1624-30.
Shi Z, Yang Y, Ma L, et al. Lamivudine in late pregnancy to inter- rupt in utero transmission of hepatitis B virus: a systematic review and meta-analysis. Obstet Gynecol 2010; 116:147-59.
Bzowej NH. Hepatitis B therapy in pregnancy. Curr Hepatitis Rep 2010; 9:197-204.