Liver Eosinophilic Infiltrate Is a Significant Finding in Patients With Chronic Hepatitis C

G. Tarantino; D. Cabibi; C. Cammà; N. Alessi; M. Donatelli; S. Petta; A. Craxì; V. Di Marco


J Viral Hepat. 2008;15(7):523-530. 

In This Article

Summary and Introduction

Eosinophilic infiltrate of liver tissue is described in primary cholestatic diseases, hepatic allograft rejection and drug-induced liver injury, but its significance and its implications in chronic hepatitis C are unknown. The aim of this study was to investigate the clinical significance of eosinophilic liver infiltrate in patients with chronic hepatitis C. We retrospectively evaluated 147 patients with chronic hepatitis C. The presence of eosinophilic infiltrate was investigated in liver biopsies, and a numeric count of eosinophilic leucocytes in every portal tract was assessed. An eosinophilic infiltrate of liver tissue (≥3 cells evaluated in the portal / periportal spaces) was observed in 46 patients (31%), and patients who consumed drugs had an odds ratio (OR) of 4.02 (95% CI: 1.62-9.96) to have an eosinophilic infiltrate in liver biopsy. By logistic regression analysis, the presence of steatosis was independently associated with eosinophilic infiltrate (OR 5.86; 95% CI: 2.46-13.96) and homeostasis model assessment-score (OR 1.18; 95% CI: 1.00-1.39). Logistic regression analysis also showed that fibrosis staging ≥ 2 by Scheuer score was associated with grading >1 by Scheuer score (OR 6.82; 95% CI 2.46-18.80) and eosinophilic infiltrate (OR 4.00; 95% CI 1.23-12.91). In conclusion, we observed that the eosinophilic infiltrate of liver tissue was significantly more frequent in patients who assumed drugs, and found a significant association between eosinophilic infiltrate, liver steatosis and liver fibrosis. These preliminary data could lead to a constant assumption of drugs as a co-factor of eosinophils-mediated liver injury in chronic hepatitis C.

Chronic hepatitis C in developed countries is a common cause of chronic hepatic injury, liver transplantation and liver related death.[1] In HCV hepatic disease, the co-factors of liver damage are viral co-infections, liver steatosis, alcohol abuse and liver iron overload.[2] The presence of concomitant diseases and, consequently, of chronic drug assumption has not been investigated as a possible risk factor for severe liver damage in chronic hepatitis C. In this context a tissue infiltrate of eosinophilic leucocytes has very rarely been described, and its significance is unknown. Conversely an infiltration of eosinophilic leucocytes has been described in various liver diseases, including primary biliary cirrhosis (PBC),[3,4,5,6,7,8,9] primary sclerosing cholangitis (PSC),[10,11,12] idiopathic hypereosinophilic syndrome,[13,14,15,16] hepatic allograft rejection,[17,18,19,20,21,22,23,24,25,26] graft-vs-host disease[27] and drug-induced liver injuries.[28,29,30,31,32,33,34]

Experimental models have reported that activated Kupffer cells play a key role in producing the cytotoxicity of eosinophils by releasing TNF-α[35,36] a process that in evidenced, specifically, by liver biopsy of patients with drug-induced liver injuries.[37,38]

Our study was designed to examine the prevalence of eosinophilic infiltrate (EI) in liver biopsies of patients with chronic hepatitis C and to investigate the relations between eosinophilic infiltration of liver tissue and clinical features, current and / or recent assumption of drugs, and histological features.


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