Advertisement

Journal of Gastroenterology

, Volume 30, Issue 5, pp 667–671 | Cite as

Three cases of primary biliary cirrhosis associated with bronchial asthma

  • Shuichi Terasaki
  • Yasuni Nakanuma
  • Masahiro Hoso
  • Hidero Ogino
  • Masashi Unoura
  • Kenichi Kobayashi
  • Yasutsugu Mizuno
  • Hikoto Nakagawa
  • Motoshige Shimizu
  • Masanobu Kanai
  • Tatsuho Sugimoto
Case Report

Abstract

The association of primary biliary cirrhosis (PBC) and bronchial asthma was observed in three patients. All of these patients were female (53, 54, and 41 years old, respectively), and were positive for antimitochondrial antibodies. The patients fulfilled the diagnostic criteria of both PBC and bronchial asthma. Bronchial asthma preceded PBC in two patients, and the reverse order was seen in the other. Patient the clinical symptoms were mainly due to the bronchial asthma. Two patients had asymptomatic PBC and the third patient complained of pruritus. The liver histology showed mild to moderate eosinophilic infiltration in addition to the ductal and hepatic parenchymal changes characteristic of PBC. A survey of 266 cases of PBC referred to us disclosed that, in 6 of these, the PBC was associated with bronchial asthma, while no association with bronchial asthma was the material of found in 166 patients with viral hepatitis in our liver biopsy files. The 3 present cases we experienced suggest that bronchial asthma may be included in the list of extrahepatic diseases associated with PBC. The significance of this association is unclear and may merit further study. Steroid therapy, which is known to cause adverse effects in PBC, was employed for bronchial asthma in these 3 patients. Another therapeutic approach will have to be considered in patients with bronchial asthma associated with PBC.

Key words

primary biliary cirrhosis bronchial asthma eosinophils 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Terasaki S, Nakanuma Y, Yamazaki M, et al. Eosinophilic infiltration in primary biliary cirrhosis: Morphological study. Hepatology 1993;17:206–212.CrossRefPubMedGoogle Scholar
  2. 2.
    Kokubun M, Kuroda M, Takagi T, et al. Eosinophilia in PBC patients (in Japanese). Japanese J of Gastroenterology 1990;87:1410–1416.Google Scholar
  3. 3.
    Watanabe M, Suzuki T, Takayama M. Several interesting findings in primary biliary cirrhosis with an emphasis on eosinophilia and cardiopulmonary findings (in Japanese). Niigata Med J 1986;100:225.Google Scholar
  4. 4.
    Wiesner RH, LaRusso NF, Ludwig J, et al. Comparison of the clinicopathologic features in primary sclerosing cholangitis and primary biliary cirrhosis. Gastroenterology 1985;88:108–114.PubMedGoogle Scholar
  5. 5.
    Ludwing J, Dickson ER, McDonald GSA. Staging of crhonic nonsuppurative destructive cholagnitis (syndrome of primary biliary cirrhosis). Virchows Arch [A] 1978;379:103–112.Google Scholar
  6. 6.
    Kierszenbaum F, Willalta F, Tai PC. Role of inflammatory cells in Chagas' disease. III. Kinetics of human eosinophil activation upon interaction parasites (Trypanosoma cruzi). J Immunol 1986;136:662–666.PubMedGoogle Scholar
  7. 7.
    Scheuer PJ. Liver biopsy interpretation. 3rd ed. London: Bailliere-Tindall, 1980.Google Scholar
  8. 8.
    Culp KS, Fleming CR, Duffy J, et al. Autoimmune associations in primary biliary cirrhosis. Mayo Clin Proc 1982;57:365–370.PubMedGoogle Scholar
  9. 9.
    Sasaki H, Inoue K, Higuchi K, et al. Primary biliary cirrhosis in Japan: Natural survey by the subcommittee on autoimmune hepatitis. Gastroenterol Jpn 1985;20:476–485.PubMedGoogle Scholar
  10. 10.
    Nakanuma Y. Nodular regenerative hyperplasia of the liver: Retrospective survey in autopsy series. J Clin Gastroenterol 1990;12:460–465.PubMedGoogle Scholar
  11. 11.
    Osaka M, Aramaki T, Okumura H, et al. Primary biliary cirrhosis with fibrosing alveolitis. Gastroenterol Jpn 1988;23:457–460.PubMedGoogle Scholar
  12. 12.
    Rodrignez-Roisin R, Pares A, Bruguera M, et al. Pulmonary involvement in primary biliary cirrhosis. Thorax 1981;36:208–212.Google Scholar
  13. 13.
    Wallert B, Bonnieve P, Prin L, et al. Primary biliary cirrhosis. Subclinical inflammatory alveolitis in patients with normal chest roentgenograms. Chest 1986;90:842–848.Google Scholar
  14. 14.
    Foster PF, Bhattacharyya A, Sankary HN, et al. Eosinophil cationic protein's role in human hepatic allograft rejection. Hepatology 1991;13:1117–1125.CrossRefPubMedGoogle Scholar
  15. 15.
    Foong A, Scholes JV, Gleich GJ, et al. Eosinophil-induced chronic active hepatitis in the idiopathic hypereosinophilic syndrome. Hepatology 1991;13:1090–1094.CrossRefPubMedGoogle Scholar
  16. 16.
    Croffy B, Kopelman R, Kaplan H. Hypereosinophilic syndrome: Association with chronic active hepatitis. Dig Dis Sci 1988;33:233–239.CrossRefPubMedGoogle Scholar
  17. 17.
    Kagawa T, Suematsu M, Miura S, et al. A case of primary sclerosing cholangitis with eosinophilia (in Japanese). Sogorinsho 1988;9:2339–2342.Google Scholar
  18. 18.
    Panush RS, Wilkinson LS, Fagin LS. Chronic active hepatitis associated with eosinophilia and Coombs'-positive hemolytic anemia. Gastroenterology 1973;64:1015–1019.PubMedGoogle Scholar
  19. 19.
    Gomperts BD, Cromwell O. Secretory properties of eosinophils. Clin Exp Allergy 1991;21:24–28.PubMedGoogle Scholar
  20. 20.
    Roitt IM, Brostoff J, Male DK. Immunology. London: Gover Medical Publishing, 1985.Google Scholar
  21. 21.
    Enokihara H, Hamaguchi H, Sakamaki H, et al. Specific production of eosinophil colony-stimulating factor from sensitized T cells from a patient with allergic eosinophilia. Br J Haematol 1985;59:85–91.PubMedGoogle Scholar
  22. 22.
    Gittlen SD, Schulman ES, Maddrey WC. Raised histamine concentrations in chronic liver disease. Gut 1990;31:96–99.PubMedGoogle Scholar
  23. 23.
    Clutterbuck EJ, Hirst EMA, Sanderson CJ. Human interleukin-5 (IL-5) regulates the production of eosinophils in human bone marrow cultures: Comparison and interaction with IL-1, IL-3, IL-6, and GMCSF. Blood 1989;73:1504–1512.PubMedGoogle Scholar
  24. 24.
    Kay AB. Studies on eosinophil leucocyte migration. II. Factors specially chemotactic for eosinophils and neutrophils generated from guinea pig serum by antigen-antibody complexes. Clin Exp Immunol 1970;7:723–737.PubMedGoogle Scholar
  25. 25.
    Gershwin ME, Mackay IR. Primary biliary cirrhosis: Paradigm or paradox for autoimmunity. Gastroenterology 1991;100:822–833.PubMedGoogle Scholar
  26. 26.
    Sherlock S, Dooley J. Diseases of the liver and biliary system, 9th ed. London: Blackwell Scientific, 1993.Google Scholar

Copyright information

© Springer-Verlag 1995

Authors and Affiliations

  • Shuichi Terasaki
    • 1
    • 2
  • Yasuni Nakanuma
    • 1
  • Masahiro Hoso
    • 1
  • Hidero Ogino
    • 2
  • Masashi Unoura
    • 2
  • Kenichi Kobayashi
    • 2
  • Yasutsugu Mizuno
    • 3
  • Hikoto Nakagawa
    • 4
  • Motoshige Shimizu
    • 5
  • Masanobu Kanai
    • 6
  • Tatsuho Sugimoto
    • 6
  1. 1.Second Department of PathologyKanazawa University School of MedicineKanazawaJapan
  2. 2.Department of Internal MedicineKanazawa University School of MedicineKanazawaJapan
  3. 3.Yamanaka National HospitalEnumaJapan
  4. 4.Toyama Prefectural Central HospitalToyamaJapan
  5. 5.Fukui Red Cross HospitalFukuiJapan
  6. 6.Tonami General HospitalTonamiJapan

Personalised recommendations