Abstract
Hepatitis of any etiology routinely presents with elevated transaminases. However, the presence of cholestasis should not necessarily rule out the presence of viral or alcoholic hepatitis. Hepatotropic viruses, such as hepatitis A, B, C, and E, can present with an elevated alkaline phosphatase and hyperbilirubinemia. Cytomegalovirus and Epstein-Barr virus infections may also present in this manner. Alcoholic hepatitis, often defined by an AST/ALT ratio of 2–3:1, can have cholestatic characteristics, as well. A careful clinical history, viral serologies, and, in some cases, a liver biopsy can clarify these disease states.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Burgart LJ. Cholangitis in viral disease. Mayo Clin Proc 1998; 73: 479–482.
Eppinger H. (1937) Die Leberkrankheiten: allgemeine und spezialle Pathologie und Therapie der Leber. Julius Springer, Vienna.
Watson CJ and Hoffbauer W. The problem of prolonged hepatitis with particular reference to cholangiolitic cirrhosis of the liver. Ann Intern Med 1946; 25: 227.
Gall EA and Braunstein H. Hepatitis with manifestations simulating bile duct obstruction (so-called “cholangiolitic hepatitis”). Am J Clin Pathol 1955; 25: 1113–1127.
Ellakim M and Rachmilewitz M. Cholangiolitic manifestations in viral hepatitis. Gastroenterology 1956; 31: 369–383.
Sheldon S and Sherlock S. Viral hepatitis with features of prolonged bile retention. Br Med J 1957; 2: 734–738.
Dubin IN, Sullivan BH, LeGolvan PC, and Murphy LC. The cholestatic form of viral hepatitis. Am J Med 1960; 29: 55–72.
Schiff ER. A typical clinical manifestations of hepatitis A. Vaccine 1992; 10: S18–S20.
Verucchi G, Calza L, and Chiodo F. Viral hepatitis A with atypical course. Clinical, biochemical, and virologic study of 7 cases. Ann Ital Med Int 1999; 14: 239–245.
Ciocca M. Clinical course and consequences of hepatitis A infection. Vaccine 2000; 18: S71–S74.
Texeira MR, Jr, Weller IV, Murray M, et al. The pathology of hepatitis A in man. Liver 1982; 2: 53–60.
Gordon SC, Reddy KR, Schiff L, and Schiff ER. Prolonged intrahepatic cholestasis secondary to acute hepatitis A. Ann Intern Med 1984; 101: 635–637.
Kassas AL, Telegdy L, Mehesfalvi E, Szilagyi T, and Mihaly I. Polyphasic and protracted patterns of hepatitis A infection: a retrospective study. Acta Med Hung 1994; 50: 93–98.
Cvjetkovic D, Hrnjakovic Cvjetkovic I. Peripheral blood count disorders at the beginning of icteric phase of hepatitis A in adults according to clinical form. Miner Gastroenterol Dietol 2003; 49: 225–228.
Ibarra H, Riedemann S, Froesner G, et al. Natural history of viral hepatitis A in Chilean adults: clinical and laboratory aspects. GEN 1993; 47: 25–31.
Schiraldi O, Modugno A, Miglietta A, et al. Prolonged viral hepatitis type A with cholestasis: case report. Ital J Gastroenterol 1991; 23: 364.
Tong MJ el-Farra NS, and Grew MI. Clinical manifestations of hepatitis A: Recent experience in a community teaching hospital. J Infect Dis 1995; 171: S15–S18.
Agarwal KS, Puliyel JM, Mathew A, Lahoti D, and Gupta R. Acute pancreatitis with cholestatic hepatitis: an unusual manifestation of hepatitis A. Ann Trop Paediatr 1999; 19: 391–394.
Ilan Y, Hillman M, Oren R, Zlotogorski A, and Shouval D. Vasculitis and cryoglobulinemia associated with persisting cholestatic hepatitis A virus infection. Am J Gastroenterol 1990; 85: 586–587.
Werblowsky-Constantini N, Livshin R, Burstein M, Zeligowski A, and Tur-Kaspa R. Toxic epidermal necrolysis associated with acute cholestatic viral hepatitis A. J Clin Gastroenterol 1989; 11: 691–693.
Jamil SM and Massry SG. Acute anuric renal failure in nonfulminant hepatitis A infection. Am J Nephrol 1998; 18: 329–332.
Malbrain MLNG, DeMeester X, Wilmer AP, et al. Another case of acute renal failure due to acute tubular necrosis (ATN), proven by renal biopsy in nonfulminant hepatitis A (HAV) infection. Nephrol Dial Transplant 1997; 12: 1543–1544.
Faust RL and Pimstone N. Acute renal failure associated with nonfulminant hepatitis A viral infection. Am J Gastroenterol 1996; 91: 369–372.
McCann UG, II, Rabito F, Shah M, Nolan CR, III, and Lee M. Acute renal failure complicating nonfulminant hepatitis A. West J Med 1996; 165: 308–310.
Lin CC, Chang CH, Lee SH, Chiang SS, and Yang AA. Acute renal failure in non-fulminant hepatitis A. Nephrol Dial Transplant 1996; 11: 2061–2066.
Odutola TA and Amira O. Non-oliguric acute renal failure in non-fulminant acute viral hepatitis. Nephrol Dial Transplant 1998; 13: 814–815.
Wolf M, Oneta CM, Jornod P, et al. Cholestatic hepatitis A complicated by acute renal insufficiency. Z Gastroenterol 2001; 39: 519–522.
Duncan CR, Palmitano JB, Tani RD, and Viola LA. Cholestatic viral hepatitis: is it an easy diagnosis? Acta Gastroenterol Latinoam 1985; 15: 225–231.
Corpechot C, Cadranel JF, Hoang C, et al. Cholestatic viral hepatitis A in adults. Clinical, biological and histopathological study of 9 cases. Gastroenterol Clin Biol 1994; 18: 743–750.
Sciot R, Van Damme B, and Desmet VJ. Cholestatic features in hepatitis A. J Hepatol 1986; 3: 172–181.
Terrault NA and Wright TL. Viral hepatitis A through G. In: Gastrointestinal and Liver Disease (Feldman M, Scharschmidt BF, and Sleisenger MH, Eds), WB Saunders, Philadelphia, 1998; p. 1129.
Cuthbert JA. Hepatitis A: old and new. Clin Microbiol Rev 2001; 14: 38–58.
Fabris P, Tositti G, Mazzella G, et al. Effect of ursodeoxycholic acid administration in patients with acute viral hepatitis: a pilot study. Aliment Pharmacol Ther 1999; 13: 1187–1193.
Chen CH, Chen PJ, Chu JS, Yeh KH, Lai MY, and Chen DS. Fibrosing cholestatic hepatitis in a hepatitis B surface antigen carrier after renal transplantation. Gastroenterology 1994; 107: 1514–1518.
Duseja A, Nada R, Kalra N, et al. Fibrosing cholestatic hepatitis-like syndrome in a hepatitis B virus and hepatitis C virus-negative renal transplant recipient: a case report with autopsy findings. Trop Gastroenterol. 2003; 24: 31–34.
Poulet B, Chapel F, Deny P, et al. Fibrosing cholestatic hepatitis by B virus reactivation in AIDS. Ann Pathol 1996; 16: 188–191.
Fang JW, Wright TL, and Lau JY. Fibrosing cholestatic hepatitis in patient with HIV and hepatitis B. Lancet 1993; 342: 1175.
Cooksley WG and McIvor CA. Fibrosing cholestatic hepatitis and HBV after bone marrow transplantation. Biomed Pharmacother 1995; 49: 117–124.
McIvor C, Morton J, Bryant A, Cooksley WG, Durrant S, and Walker N. Fatal reactivation of precore mutant hepatitis B virus associated with fibrosing cholestatic hepatitis after bone marrow transplantation. Ann Intern Med 1994; 121: 274–275.
O’Grady JG, Smith HM, Davies SE, et al. Hepatitis B virus reinfection after orthotopic liver transplantation. Serological and clinical implications. J Hepatol 1992; 14: 104–111.
Davies SE, Portmann BC, O’Grady JG, et al. Hepatic histological findings after transplantation for chronic hepatitis B virus infection, including a unique pattern of fibrosing cholestatic hepatitis. Hepatology 1991; 13: 150–157.
Benner KG, Lee RG, Keeffe EB, Lopez RR, Sasaki AW, and Pinson CW. Fibrosing cytolytic liver failure secondary to recurrent hepatitis B after liver transplantation. Gastroenterology 1992; 103: 1307–1312.
Mason AL, Wick M, White HM, et al. Increased hepatocyte expression of hepatitis B virus transcription in patients with features of fibrosing cholestatic hepatitis. Gastroenterology 1993; 105: 237–244.
Lau JY, Bain VG, Davies SE, et al. High-level expression of hepatitis B viral antigens in fibrosing cholestatic hepatitis. Gastroenterology 1992; 102: 956–962.
Brind AM, Bennett MK, and Bassendine MF. Nucleotide analogue therapy in fibrosing cholestatic hepatitis—a case report in an HBsAg positive renal transplant recipient. Liver 1998; 18: 134–139.
Chan T-M, Wu P-C, Li F-K, et al. Treatment of fibrosing cholestatic hepatitis with lamivudine. Gastroenterology 1998; 115: 177–181.
Faraidy KA, Yoshida EM, Davis GE, et al. Alteration of the dismal natural history of fibrosing cholestatic hepatitis secondary to hepatitis B virus with the use of lamivudine. Transplantation 1997; 64: 926–928.
Lo CM, Cheung ST, Ng IO, Liu CL, Lai CL, and Fan ST. Fibrosing cholestatic hepatitis secondary to precore/core promoter hepatitis B variant with lamivudine resistance: successful retransplantation with combination adefovir dipivoxil and hepatitis B immunoglobulin. Liver Transplant 2004; 10: 557–563.
Walsh KM, Woodall T, Lamy P, Wight DG, Bloor S, and Alexander GJ. Successful treatment with adefovir dipivoxil in a patient with fibrosing cholestatic hepatitis and lamivudine resistant hepatitis B virus. Gut 2001; 49: 436–440.
Beckebaum S, Malago M, Dirsch O, et al. Efficacy of combined lamivudine and adefovir dipivoxil treatment for severe HBV graft reinfection after living donor liver transplantation. Clin Transplant 2003; 17: 554–559.
Tillmann HL, Bock CT, Bleck JS, et al. Successful treatment of fibrosing cholestatic hepatitis using adefovir dipivoxil in a patient with cirrhosis and renal insufficiency. Liver Transplant 2003; 9: 191–196.
Schugler L, Sheiner P, Thung S, et al. Severe recurrent hepatitis C following orthotopic liver transplantation. Hepatology 1996; 23: 971–976.
Dickson RC, Caldwell SH, Ishitani MB, Lau JYN, Driscoll CJ, and Stevenson WC. Clinical and histologic patterns in early graft failure due to recurrent hepatitis C infection after liver transplantation. Transplantation 1996; 61: 701–705.
Doughty AL, Spencer JD, Cossart YE, and McCaughan GW. Cholestatic hepatitis post liver transplant is associated with persistingly high serum hepatitis C viral loads. Liver Transplant Surg 1998; 4: 15–21.
Gopal DV and Rosen HR. Duration of antiviral therapy for cholestatic HCV recurrence may need to be indefinite. Liver Transplant 2003; 9: 348–353.
Boletis JN, Delladetsima JK, Makris F, et al. Cholestatic syndromes in renal transplant recipients with HCV infection. Transplant Int 2000; 13: S375–S379.
Mechnik L, Bergman N, Attali M, et al. Acute hepatitis E virus infection presenting as a prolonged cholestatic jaundice. J Clin Gastroenterol 2001; 33: 421–422.
Asher LV, Innis BL, Shrestha MP, Ticehurst J, and Baze WB. Virus-like particles in the liver of a patient with fulminant hepatitis and antibody to hepatitis E virus. J Med Viro 1990; 31: 229–233.
Chau TN, Lai ST, Tse C, et al. Epidemiology and Clinical Features of Sporadic Hepatitis E as Compared with Hepatitis A. Am J Gastroenterol 2006; 101: 292–296.
Serna-Higuera C, Gonzalez-Garcia M, Milicua JM, and Munoz V. Acute cholestatic hepatitis by cytomegalovirus in an immunocompetent patient resolved with ganciclovir. J Clin Gastroenterol 1999; 29: 276–277.
Agarwal SK, Kalra V, Dinda A, et al. Fibrosing cholestatic hepatitis in renal transplant recipient with CMV infection: a case report. Int Urol Nephrol 2004; 36: 433–435.
Munoz de Bustillo E, Benito A, Colina F, et al. Fibrosing cholestatic hepatitis-like syndrome in hepatitis B virus—negative and hepatitis C virus—negative renal transplant recipients. Am J Kidney Dis 2001; 38: 640–645.
Horwitz CA, Burke MD, Grimes P, et al. Hepatic function in mononucleosis induced by Epstein-Barr virus and cytomegalovirus. Clin Chem 1980; 26: 243–246.
Mandell GL, Bennett JE, and Dolin R. Epstein-Barr virus, Princ Prac. Infect Dis 2000; 2: 1601–1602.
Dinulos J, Mitchell DK, Egerton J, et al. Hydrops of the gallbladder associated with Epstein-Barr virus infection: a report of two cases and review of the literature. Pediatr. Infect Dis J 1994; 13: 924–929.
Edoute Y, Baruch Y, Lachte J, et al. Severe cholestatic jaundice induced by Epstein-Barr virus infection in the elderly. J Gastroenterol Hepatol 1998; 13: 821–824.
Bernstein CN and Minuk GY. Infectious mononucleosis presenting with cholestatic liver disease. Ann Intern Med 1998; 128: 509.
Hinedi TB and Koff RS. Cholestatic hepatitis induced by Epstein-Barr virus infection in an adult. Dig Dis Sci 2003; 48: 539–541.
Yuge A, Kinoshita E, Moriuchi M, et al. Persistent hepatitis associated with chronic active Epstein-Barr virus infection. Pediatr Infect Dis J 2004; 23: 74–76.
Barlow G, Kilding R, and Green ST. Epstein-Barr virus infection mimicking extra hepatic biliary obstruction. J R Soc Med 2003; 93: 316–318.
Sung RY, Peck R, and Murray HG. Persistent high fever and gall-bladder wall thickening in a child with primary Epstein-Barr viral infection, Aust Paediatr J 1989; 25: 368–369.
Valentini P, Angelone DF, Miceli Sopo S, et al. Cholestatic jaundice in infectious mononucleosis. Miner Pediatr 2000; 52: 303–306.
Cotton WK, McFadden JW, and Walls LL. Case report: atypical presentation of cholestatic jaundice. Postgrad Med 1976; 60: 259–261.
O’Donovan N and Fitzgerald E. Gallbladder wall thickening in infectious mononucleosis: an ominous sign. Postgrad Med J 1996; 72: 299–300.
Ghosh A, Ghoshal UC, Kochhar R, et al. Infectious mononucleosis hepatitis: report of two patients. Indian J Gastroenterol 1997; 16: 113–114.
Kimura H, Nagasaka T, Hoshino Y, et al. Severe hepatitis caused by Epstein-Barr virus without infection of hepatocytes. Hum Pathol 2001; 32: 757–762.
Deutsch M, Dourakis SP, Sevastianos VA, et al. Deep jaundice in an adolescent, Postgrad Med J 2003; 79: 548–549.
Massei F, Palla G, Ughi C, et al. Cholestasis as a presenting feature of acute Epstein-Barr virus infection. Pediatr Infect Dis J 2001; 20: 721–722.
Tahan V, Ozaras R, Uzunismail H, et al. Infectious mononucleosis presenting with severe cholestatic liver disease in the elderly. J Clin Gastroenterol 2001; 33: 88–89.
Mallory F. Cirrhosis of the liver. Five different types of lesions from which it may arise. Bull Johns Hopkins Hosp 1911; 22: 69–75.
Phillips GB and Davidson CS. Acute hepatic insufficiency of the chronic alcoholic. Clinical and pathologic study. Arch Intern Med 1954; 94: 585–603.
Beckett AG, Livingstone AV, and Hill KR. Acute alcoholic hepatitis. Br Med J 1961; 2: 1113–1119.
Maddrey WC, Boitnott JK, Bedine MS, Weber FL, Mezey E, and White RI. Corticosteroid therapy of alcoholic hepatitis. Gastroenterology 1978; 75: 193–199.
Carithers RL, Jr, Herlong HF, Diehl AM, et al. Methylprednisolone therapy in patients with severe alcoholic hepatitis: a randomized multicenter trial. Ann Intern Med 1989; 110: 685–690.
Maddrey WC. Is therapy with testosterone or anabolic-androgenic steroids useful in the treatment of alcoholic liver disease? Hepatology 1986; 6: 1033–1035.
Ramond MJ, Poynard T, Rueff B, et al. A randomized trial of prednisolone in patients with severe alcoholic hepatitis. N Engl J Med 1992; 326: 507–512.
Mathurin P, Mendenhall CL, Carithers RL, et al. Corticosteroids improve short-term survival in patients with severe alcoholic hepatitis (AH): individual data analysis of the last three randomized placebo controlled double blind trials of corticosteroids in severe AH. J Hepatol 2002; 36: 480–487.
Trinchet JC, Gerhardt MF, Balkau B, Munz C, and Poupon RE. Serum bile acids and cholestasis in alcoholic hepatitis. Relationship with usual liver tests and histological features. J Hepatol 1994; 21: 235–240.
Nissenbaum M, Chedid A, and Mendenhal C. For the VA Cooperative Study Group #119. Prognostic significance of cholestatic alcoholic hepatitis. Dig Dis Sci. 1990; 35: 891–896.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2008 Humana Press Inc., Totowa, NJ
About this chapter
Cite this chapter
Khalid, S., Crippin, J.S. (2008). Cholestatic Variants of Viral Disease and Alcohol. In: Lindor, K.D., Talwalkar, J.A. (eds) Cholestatic Liver Disease. Clinical Gastroenterology. Humana Press. https://doi.org/10.1007/978-1-59745-118-5_7
Download citation
DOI: https://doi.org/10.1007/978-1-59745-118-5_7
Publisher Name: Humana Press
Print ISBN: 978-1-58829-838-6
Online ISBN: 978-1-59745-118-5
eBook Packages: MedicineMedicine (R0)