A 33-year-old patient with no history of interest was diagnosed with ileal Crohn's disease in early 2005.
She continued treatment with carnoseral 500 mg/8h and azathioprine at a dose of 150 mg/day since December 2005 due to corticosteroids.
He was also being treated with oral iron in quarterly rounds, monthly intramuscular vitamin B12 and folic acid two days a week.
Since then the patient was asymptomatic.
In January 2007, an increase in the number of enzymes associated with stasis maintained over time was observed, allowing outpatient extension of the study and removal of azathioprine.
Personal hygiene: arterial hypertension: 100/60 mm/seg; POS: 70 bpm; Temperature: 36oC; Weight: 80 kg; Talla: 180 cm; Good general condition.
Aware and oriented.
Cardiopulmonary arrest normal.
The abdomen was blushing, depressible, non-painful, with no masses or enlargement.
Lower extremities were normal.
Persistence of stasis is achieved:
Analytical.
Blood count and coagulation were normal.
Platelets: 108,000/ml.
Hepatic profile: Transaminase normal.
FA: 248U/L. GGT: 390U/L. Negative ferric profile and autoimmunity.
Serology was negative for hepatitis B and C virus.
Abdominal ultrasound.
Diffusely enlarged liver with smooth contour and diffusely tosque parenchyma, heterogeneous and hyperechogenic, without occupational lesions.
Located stricture.
Normal door opening and permeability.
Rest of structures without alterations.
Abdominal MRI.
Diffusely enlarged liver, smooth contour and homogeneous hyperparenchyma in the T1 sequences of medium level, in the T2 sequences appears hypointense, with diffuse occupational patchy areas, discrete.
Located stricture.
Rest of structures without alterations.
Gastroscopy.
In the lower third of the esophagus, there are three small varicose cords that disappear with the non-fixation.
Despite removal of dexamethasone, a liver biopsy showed preserved general architecture.
Some portal spaces are widened with incomplete port-portal bridge.
Isolated centrilobular veins.
No stasis or stenosis was observed.
No macrophages.
PAS diastase positive.
Some portal spaces present a slight round cell infiltrate that does not overflow the limiting plate.
The trabeculae of irregular hepatocytes show a pattern in regenerative zones and in pavement zones.
Binucleated cells and vascular structures frequently appear, as well as vascular structures with a peliotic pattern.
An irregular reticulin frame with collapsed areas was observed.
The histology described above is compatible with nodular regenerative hyperplasia.
1.
The subsequent evolution, both analytical and portal hypertension data, was good with normal laboratory results and disappearance of esophageal varices.
