Recently, we frequently detected immunoglobulin M (IgM) anti-HSV antibody in patients with PBC. Twenty-two (55%) of 40 patients were positive (cutoff index >1.2) for IgM anti-HSV, 13 (33%) were negative (<0.8), and five (12%) were undetermined (0.8-1.2) (Fig. 1). Nineteen of 22 patients

with positive IgM Selleck ACP-196 anti-HSV were positive for immunoglobulin G (IgG) anti-HSV, and three were negative. Nine of 13 patients with negative IgM anti-HSV were positive for IgG anti-HSV, and four were negative. Four of five undetermined patients were positive for IgG anti-HSV, and one was negative. Nakamura et al.5 reported that two different progression types exist in PBC and that positive anti-gp210 (antinuclear membrane) and positive anticentromere antibodies represent the hepatic failure type and portal hypertension type, respectively. All five patients selleck chemical with antinuclear membrane antibodies showed strong positivity (Fig. 1, arrows).

Five of 13 patients with anticentromere antibodies showed weak positivity (Fig. 1, arrowheads). Our results support environmental factors involved in the etiology of PBC, although further studies should be done to evaluate whether HSV is an infectious agent or whether IgM anti-HSV is the result of a response to cross-reactive cellular proteins. Keiichi Fujiwara M.D, Ph.D.*, Osamu Yokosuka M.D., Ph.D.*, * Department of Medicine and Clinical Oncology, Graduate School of Medicine, Paclitaxel molecular weight Chiba University, Chiba, Japan. “
“Hepatic infections with Candida species are largely restricted

to patients with severe immunosuppression. The most common setting is patients with leukemia who can develop a systemic infection during the recovery phase from severe neutropenia. Candida infections can also occur in the acquired immunodeficiency syndrome (AIDS) and in patients who are immunosuppressed after transplantation. Most infections are thought to spread to the liver from the gastrointestinal tract resulting in either microabscesses or macroabscesses and disseminated candidiasis. Granulomas can also be seen at histology in those patients who have a liver biopsy. Clinical features include fever, nausea, vomiting, abdominal pain and tender hepatomegaly. Liver function tests are usually abnormal, particularly an elevated serum alkaline phosphatase. Treatment options include amphotericin B and fluconazole but responses are often poor and mortality rates remain high. In the patient illustrated below, Candida liver abscesses were associated with Candida endocarditis. The patient was a 52-year-old woman who had cirrhosis caused by hepatitis C. She had recently been treated at another hospital for resistant spontaneous bacterial peritonitis, initially with ceftriaxone and subsequently with vancomycin and metronidazole. Despite this, she had continuing upper abdominal pain, abdominal distension, anorexia and weight loss. On physical examination, she was cachectic and had an early diastolic murmur in the aortic area.

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