Chung JH, Lim SC, Yun NR, Shin SH, Kim CM, Kim DM. Scrub typhus hepatitis confirmed by immunohistochemical staining. World J Gastroenterol 2012; 18(36): 5138-5141 [PMID: 23049227 DOI: 10.3748/wjg.v18.i36.5138]
Corresponding Author of This Article
Dong-Min Kim, Professor, Department of Internal Medicine, Chosun University College of Medicine, 588 Seosuk-dong, Dong-gu, Gwangju 501-717, South Korea. drongkim@chosun.ac.kr
Article-Type of This Article
Case Report
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World J Gastroenterol. Sep 28, 2012; 18(36): 5138-5141 Published online Sep 28, 2012. doi: 10.3748/wjg.v18.i36.5138
Scrub typhus hepatitis confirmed by immunohistochemical staining
Jong-Hoon Chung, Sung-Chul Lim, Na-Ra Yun, Sung-Heui Shin, Choon-Mee Kim, Dong-Min Kim
Jong-Hoon Chung, Na-Ra Yun, Dong-Min Kim, Department of Internal Medicine, Chosun University College of Medicine, Gwangju 501-717, South Korea
Sung-Chul Lim, Sung-Heui Shin, Choon-Mee Kim, Dong-Min Kim, Research Center for Resistant Cells, Chosun University, Gwangju 501-717, South Korea
Sung-Chul Lim, Department of Pathology, Chosun University College of Medicine, Gwangju 501-717, South Korea
Sung-Heui Shin, Department of Microbiology, Chosun University College of Medicine, Gwangju 501-717, South Korea
Author contributions: Chung JH and Lim SC contributed equally to this work; Chung JH, Lim SC and Kim DM conceived, designed and wrote the paper; Yun NR, Shin SH and Kim CM contributed reagents/materials/analytic tools.
Supported by The Korea Science and Engineering Foundation Grant Funded by the Korean Government through the Research Center for Resistant Cells, No. R13-2003-009
Correspondence to: Dong-Min Kim, Professor, Department of Internal Medicine, Chosun University College of Medicine, 588 Seosuk-dong, Dong-gu, Gwangju 501-717, South Korea. drongkim@chosun.ac.kr
Telephone: +82-62-2203108 Fax: +82-62-2349653
Received: April 12, 2012 Revised: July 20, 2012 Accepted: July 28, 2012 Published online: September 28, 2012
Abstract
Scrub typhus is an acute febrile disease caused by Orientia tsutsugamushi (O. tsutsugamushi). We report herein the case of a woman who presented with fever and elevated serum levels of liver enzymes and who was definitively diagnosed with scrub typhus by histopathological examination of liver biopsy specimens, serological tests and nested polymerase chain reaction. Immunohistochemical staining using a monoclonal anti-O. tsutsugamushi antibody showed focally scattered positive immunoreactions in the cytoplasm of some hepatocytes. This case suggests that scrub typhus hepatitis causes mild focal inflammation due to direct liver damage without causing piecemeal necrosis or interface hepatitis. Thus, scrub typhus hepatitis differs from acute viral hepatitis secondary to liver damage due to host immune responses, which causes severe lobular disarray with diffuse hepatocytic degeneration, necrosis and apoptosis as well as findings indicative of hepatic cholestasis, such as hepatic bile plugs or brown pigmentation of hepatocytes.
