Active substances: Doxycycline
Serological tests were performed, where the following results were negative: IgM antibody for hepatitis A, superficial hepatitis B antigen, anti-IgM antibodies against hepatitis B, anti-hepatitis C antibodies, and IgG and IgM antibodies against hepatitis E; others such as IgG and IgM antibodies against herpes virus 1 were reported in 2.
IgG and IgM antibodies against Toxoplasma reported the following results: 0. Three days later, to rule out a false negative, new antibody titers against Toxoplasma were ordered which reported 0.
In addition, the patient underwent a liver biopsy guided by ultrasound without complications. The biopsy findings and immunohistochemical panel are reported in Figures 1 and 2.
We used a Toxoplasma gondii rabbit polyclonal antibody manufactured by Cell Marque ref. Figure 1 Histological findings.
Figure 2 Immunohistochemistry findings. Once the biopsy was reported, in correlation with the clinical evolution and laboratory results, the patient was diagnosed with acute hepatitis secondary to Toxoplasma gondii; therefore, treatment was immediately started two days before leaving the hospital with doxycycline 100 mg PO BID, clindamycin 600 mg PO TID, and azithromycin 500 mg PO QD for 10 days.
After its emplacement, the patient showed a favorable clinical response. Discussion Toxoplasma gondii is a protozoan transmitted through the ingestion of poorly cooked meat with cysts and contaminated food or water with oocysts eliminated through cat feces.
Some other less frequent forms of presentation are described such as encephalitis, retinitis, pneumonitis, myocarditis, myositis, and in rare cases acute hepatitis.
These seldom forms of presentation usually occur in immunocompromised patients HIV-positive and posttransplant recipients and only as anecdotal cases in immunocompetent patients. Most of the cases of hepatitis secondary to Toxoplasma gondii have been reported in Brazil, El Salvador, Turkey, and France, among others.
In our patient, these findings were never reported in the laboratories, despite the abundant eosinophilia and lymphoid infiltration in the liver biopsy.
There are several serological methods for the diagnosis of toxoplasmosis including indirect hemagglutination, indirect immunofluorescence, ELISA, and more recently western blotting as well as recently developed PCR techniques.
In the cases of acute Toxoplasma-related hepatitis reported by Atilla et al. The clear supernatant was collected and used for gelatinase zymography, as described below.
Gelatinase zymography Gelatinase zymography was utilized because of its high sensitivity to gelatinolytic enzymatic activity and ability to detect both pro and active forms of MMP-2 and MMP-9.
Upon renaturation of the enzyme, the gelatinases digest the gelatin in the gel and reveal clear bands against an intensely stained background.
Samples were not boiled before electrophoresis. Following electrophoresis the gels were washed twice in 2.
Protein standards were run concurrently and approximate molecular weights were determined by plotting the relative mobilities of known proteins.
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