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Organ transplant recipients living in endemic regions are at increased risk of Leishmania infections. Visceral leishmaniasis is the most common kind of presentation in the Mediterranean basin. Rarely, Leishmania infantum may cause localized mucosal disease. We present the first case, to our knowledge, of a liver transplant recipient with localized mucosal leishmaniasis. Twenty-two years after transplantation, a painless, very slow growing ulcer appeared on the inner side of the patient's upper lip. A biopsy performed in the community hospital showed non-specific chronic inflammation without neoplastic signs. Because of a high suspicion of malignancy, the patient was transferred to the referral hospital to consider complete excision. The excisional biopsy revealed a granulomatous inflammatory reaction together with intracellular Leishmania amastigotes within macrophages. Leishmaniasis was confirmed by the nested polymerase chain reaction assay. The clinical and laboratory findings did not suggest visceral involvement. The patient received meglumine antimoniate for 21 days without relevant adverse effects. [ABSTRACT FROM AUTHOR]

Hypergammaglobulinemia is a well-known feature of liver cirrhosis, but studies on serum IgE in this setting are limited. The present study evaluates serum IgE concentration in a group of cirrhotic patients and examines their relationship with aetiological, clinical and analytical parameters (including liver function tests and hepatic phagocytic activity). The presence of specific IgE against common dietary antigens was also investigated. Total serum IgE was determined by enzyme immunoassay (EIA) in 52 cirrhotics (27 alcoholic and 25 non-alcoholic, including eight virus B and seven virus C-related cirrhosis, three primary biliary cirrhosis, three cryptogenic, three haemochromatosis and one Wilson's disease) and 34 healthy subjects (used as controls). Serum IgE (IU/ml) in contols was not significantly different from that of cirrhotic patients (median 42, range 2–726 vs median 86, range 2-> 1000, respectively) (P=NS). However, serum IgE among alcoholics (median 199, range 19-> 1000) was higher than that of controls (P<0 001), virus B-related cirrhotics (median 25, range 3-> 1000) (P<0.05), virus C-related cirrhotics (median 47, range 2–170) (P<0.05), or nonalcoholic cirrhotics as a whole (median 23, range 2-> 1000) (P <0.01). High IgE levels (&ges;170 IU/ml) were detected in 55 5% of alcoholics compared with only 12% of non-alcoholic-cirrhotics (P<0.01). Moreover, IgE levels were very high (> 1000 IU/ml) in six patients of the alcoholic group (22 2%) compared with only one non-alcoholic patient (4%). Increased serum IgE levels did not seem to be related to either parameters of liver function (serum bilirubin, albumin, prothrombin or Child-Pugh score), hepatic phagocytic function or other immunoglobulins. Skin-prick tests failed to demonstrate increased sensitization to eight common dietary antigens in the patients studied. On multivariate analysis, only the alcoholic aetiology of the disease correlated with high serum IgE levels. These data suggest that increased serum IgE might be a common and rather specific feature of chronic alcoholic liver disease. [ABSTRACT FROM AUTHOR]

The aim of the present study was to evaluate the influence of Kupffer cell phagocytosis blockade (KCPB) on the production of reaginic (IgE) and non-reaginic (IgGl) ovalbumin antibodies in an experimental animal model. Forty-two female heterozygous Gunn rats were injected with two 100 μg doses of ovalbumin separated by 13 days, into jugular vein (Group I, n = 10), portal vein (Group II, n = 10), jugular vein with prior KCPB (Group III, n = 10) and portal vein with prior KCPB (Group IV, n = 12). KCPB was induced with gadolinium chloride (5 mg/kg body weight, 24 hr before each ovalbumin administration). Antibodies were determined by passive cutaneous anaphylaxis in sera obtained 12 days after the first dose of ovalbumin and 8 days after the second one. No antibodies were detected at any time in Group II. The maximum response was observed in Group IV in which, after two doses of ovalbumin, 100% of the animals presented IgGl and 58% presented detectable IgE antibodies. Differences between group IV and the other groups were statistically significant. This phenomenon does not seem to be due to a systemic effect of gadolinium chloride since humoral response was not increased in Group III with respect to Group I. It is concluded that the liver represents a barrier to IgE and IgGl sensitization. KCPB not only eliminates this barrier, but also clearly increases antibody production to a protein antigen (ovalbumin) arriving at the liver through the portal vein. [ABSTRACT FROM AUTHOR]

Background and Aims: Hepatitis C (HCV) therapy with Sofosbuvir (SOF)/Simeprevir (SMV) in clinical trials and real-world clinical practice, showed high rates of sustained virological response (SVR) in non-cirrhotic genotype (GT)-1 and GT-4 patients. These results were slightly lower in cirrhotic patients. We investigated real-life effectiveness and safety of SOF/SMV with or without ribavirin (RBV) in a large cohort of cirrhotic patients., Methods: This collaborative multicentre study included data from 968 patients with cirrhosis infected with HCV-GT1 or 4, treated with SOF/SMV±RBV in 30 centres across Spain between January-2014 and December-2015. Demographic, clinical, virological and safety data were analysed., Results: Overall SVR was 92.3%; the majority of patients were treated with RBV (62%) for 12 weeks (92.4%). No significant differences in SVR were observed between genotypes (GT1a:94.3%; GT1b:91.7%; GT4:91.1%). Those patients with more advanced liver disease (Child B/C, MELD≥10) or portal hypertension (platelet count≤100×10 9 /L, transient elastography≥21 Kpa) showed significantly lower SVR rates (84.4%-91.9%) than patients with less advanced liver disease (93.8%-95.9%, P<.01 in all cases). In the multivariate analysis, the use of RBV, female gender, baseline albumin≥35 g/L, MELD<10 and lack of exposure to a triple therapy regimen were independent predictors of SVR (P<.05). Serious adverse events (SAEs) and SAE-associated discontinuation events occurred in 5.9% and 2.6%., Conclusions: In this large cohort of cirrhotic patients managed in the real-world setting in Spain, SOF/SMV±RBV yielded to excellent SVR rates, especially in patients with compensated liver cirrhosis. In addition, this combination showed to be safe, with low rates of SAEs and early discontinuations., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)