Goritsas et al. Journal of Medical Case Reports 2010, 4:9 http://www.jmedicalcasereports.com/content/4/1/9 C A S E R E P O R T Hepatic involvement in Wegener’s granulomatosis: a case report Constantin Goritsas1*, Nicolas P Paissios1, Rodoula Trigidou2, Joanna Delladetsima3 JOURNAL OF MEDICAL CASE REPORTS Open Access Abstract Introduction: We report the case of a 58-year-old Caucasian Greek man who presented with dry cough, fever, bilateral alveolar infiltrates and acute hepatitis. Case presentation: After a lung biopsy, the patient was diagnosed with Wegener’s granulomatosis. The diagnosis was supported by the presence of anti-proteinase-3 anti-neutrophil cytoplasmic antibodies. A liver biopsy demonstrated the presence of mild non-specific lobular hepatitis and periodic acid-Schiff positive Lafora-like inclusions in a large number of his liver cells. The patient was treated with prednisone and cyclophosphamide, which was followed by subsequent remissions of chest X-ray findings and liver function studies. Conclusion: What makes this case worth reporting is the coexistence of liver inflammation with a biochemical profile of severe anicteric non-viral, non-drug induced hepatitis coinciding with the diagnosis of Wegener’s granulomatosis. Our paper may be the first report of hepatic involvement in a patient diagnosed with Wegener’s granulomatosis. The aetiological link between the two diseases is supported by the reversion of hepatitis after the immunosuppression of Wegener’s granulomatosis. We favor the hypothesis that hepatic vasculitis may be the cause of acute hepatocellular necrosis. Introduction Wegener’s granulomatosis is an anti-neutrophil cyto- plasmic autoantibody (ANCA)-associated small vessel systemic vasculitis characterized primarily by necrotizing granulomatosis of the upper and lower respiratory tract and by glomerulonephritis. We report the case of a 58- year-old man with symptoms of Wegener’s granuloma- tosis who developed acute anicteric hepatitis. Case presentation A 58-year-old Caucasian man of Greek origin and nationality was transferred to our hospital’s Internal Medicine Department due to a marked elevation of his hepatic enzymes. He had a long history of rhinitis con- sidered to be of allergic origin and with an epidermal sensitivity test that was positive to parietaria species. He had no history of alcohol abuse. Nine months before he was admitted to our hospital, he developed an acute hearing loss in his right ear (trea- ted without improvement with dimenhydrinate and * Correspondence: cpgor@otenet.gr 1Department of Internal Medicine, Sotiria General Hospital, 152 Mesogeion Avenue, Athens, 11527, Greece pyridoxine by his otolaryngologist), which was followed shortly after by a worsening dry cough. Eight weeks before our evaluation, he reported fatigue, loss of appe- tite and weight loss of about 4 kg to 5 kg. In the last three weeks of that same period, his temperature rose to 38.8°C and he was treated without improvement with oral antibiotics (cefprozil and clarithromycin) by his local physician. Due to the persistence of his fever, after being treated with antibiotics for seven days he was referred by his local physician to the pneumonology department of our hospital. At that time, he was afeb- rile. Chest radiography revealed the presence of bilateral alveolar infiltrates, while liver function tests were within normal range. Bronchoscopy was negative for structural abnormalities, and culture of bronchoalveolar lavage fluid was negative. A chest computed tomography (CT) scan was performed in which the presence of multiple lung masses (nodular opacities) was noted. The result of a Mantoux skin test was negative and a complete immu- nologic serologic profile was pending when the patient was transferred to our department because of the eleva- tion of his hepatic enzymes, starting a week after his admission. © 2010 Goritsas et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.