ro13-9904 and Hepatitis-A

A 69-year-old man presented with multiple livid maculae and infiltrated urticarial plaques, as well as elevated liver enzymes. Based on typical clinical picture, histopathology and positive PCR from a skin biopsy, we diagnosed an early disseminated infection with Borrelia afzelii presenting with multiple erythema migrans (erythemata migrantia) and a subclinical hepatitis. During antibiotic treatment with intravenous ceftriaxone, the maculae and plaques vanished almost completely and the liver enzymes decreased within 14 days. Dermatologists should keep in mind that early disseminated borreliosis can present with multiple erythema migrans and hepatitis.

Topics: Aged; Alanine Transaminase; Anti-Bacterial Agents; Biopsy; Borrelia burgdorferi Group; C-Reactive Protein; Ceftriaxone; Doxycycline; Erythema Chronicum Migrans; gamma-Glutamyltransferase; Hepatitis A; Hepatomegaly; Humans; L-Lactate Dehydrogenase; Lyme Disease; Male; Skin

We report here a case of recurrent paratyphoid fever A with hepatitis A co-infection in a patient with chronic hepatitis B. A 26-year-old male patient, who was a hepatitis B virus carrier, was co-infected with Salmonella enterica serovar Paratyphi A and hepatitis A virus. The recurrence of the paratyphoid fever may be ascribed to the coexistence of hepatitis B, a course of ceftriaxone plus levofloxacin that was too short and the insensitivity of paratyphoid fever A to levofloxacin. We find that an adequate course and dose of ceftriaxone is a better strategy for treating paratyphoid fever. Furthermore, the co-infection of paratyphoid fever with hepatitis A may stimulate cellular immunity and break immunotolerance. Thus, the administration of the anti-viral agent entecavir may greatly improve the prognosis of this patient with chronic hepatitis B, and the episodes of paratyphoid fever and hepatitis A infection prompt the use of timely antiviral therapy.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Coinfection; Drug Resistance, Bacterial; Hepatitis A; Hepatitis A virus; Hepatitis B, Chronic; Humans; Levofloxacin; Male; Paratyphoid Fever; Recurrence; Salmonella paratyphi A

To report a patient with typhoid fever who presented with fulminant hepatitis and was found to have a co-infection with hepatitis A.. An 11-year-old girl presented with fever and jaundice after arrival from India. Her blood culture was positive for Salmonella typhi. While on treatment with ceftriaxone, she had worsening of her jaundice with abrupt elevation of liver transaminases associated with coagulopathy. She was found to have an associated hepatitis A infection. Liver enzymes all reverted back to normal upon follow up.. The association of typhoid fever with hepatitis A can result in fulminant hepatitis but in this case, is associated with complete recovery.

Topics: Anti-Bacterial Agents; Blood; Ceftriaxone; Child; Female; Hepatitis A; Humans; India; Kuwait; Salmonella typhi; Transaminases; Travel; Typhoid Fever

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Drug Resistance, Bacterial; Hepatitis A; Humans; Liver Failure, Acute; Male; Microbial Sensitivity Tests; Quinolones; Salmonella typhi; Typhoid Fever