OBJETIVO: avaliar a freqüência das doenças hepáticas em pacientes com esclerodermia e, secundariamente, estudar a freqüência de infecção pelos vírus B e C da hepatite nesses pacientes, assim como a freqüência de auto-anticorpos séricos. MATERIAL E MÉTODOS: estudaram-se pacientes com diagnóstico de esclerodermia, localizada ou sistêmica, acompanhados no Ambulatório de Reumatologia do Hospital Santa Izabel. Como grupo de comparação, foram estudados pacientes com diagnóstico de acne vulgar. RESULTADOS: dos 65 pacientes com diagnóstico de esclerodermia incluídos nesse trabalho, 35% apresentaram a gama-glutamiltransferase (gama-GT) alterada, 30% tiveram a fosfatase alcalina aumentada e 17,1%, a alaninoaminotransferase (ALT) acima dos valores de referência. A ALT apresentou-se mais alterada nos pacientes do que nos controles. Apenas um indivíduo dos 41 testados apresentou positividade para o anticorpo antimitocôndria enquanto 19% tinham anticorpo antimúsculo liso, não se observando diferença estatística na positividade desses anticorpos entre os dois grupos. Um paciente apresentou o HBsAg positivo e outro foi positivo para o anticorpo anti-HCV. Nenhum paciente apresentou manifestações clínicas de doença hepática. CONCLUSÕES: no presente estudo, embora as alterações de enzimas hepáticas em pacientes com esclerodermia não tenham sido incomuns, não se observou nenhum caso com manifestações clínicas de doença hepática.

INTRODUCTION: to determine the frequency of hepatic disease in patients with scleroderma and, secondarily, to investigate the frequency of hepatitis B and C virus infection and determine the frequency of autoantibodies in this disease. MATERIAL AND METHODS: patients with scleroderma followed at Hospital Santa Izabel were included in the study and patients with acne vulgaris served as a comparison group. RESULTS: considering the 65 scleroderma patients, 35% had elevated gamma-glutamyltranspeptidase (gamma-GT), 30% had elevated alkaline phosphatase and 17.1% had alanine aminotransferase (ALT) higher than the reference range. Raised ALT levels were more common in the scleroderma patients than in the control group. Nineteen percent (19%) of the patients tested positive for anti-smooth muscle antibodies and only one patient had anti-mitocondria antibodies. There was no statistical difference between the two groups regarding antibody testing. Anti-HCV antibodies were observed in one patient and HBsAg was detected in another scleroderma patient. There was no patient with clinically significant hepatic disease. CONCLUSIONS: the present study showed that clinical hepatic disease did not occur in our scleroderma patients, despite the relatively increased frequency of liver enzymes abnormalities.

The idiopathic dilated cardiomyopathy (IDMC) is a disease of the cardiac muscle characterized by systolic dilation and/or dysfunction of one or both ventricles, symptoms of congestive heart failure and risk of early death. Several studies in animal models and in humans have supported the hypothesis of the viral infection as initial event in the immunopathogenesis of the ventricular dilation. The objective of this study was to correlate the presence of hepatitis C virus chronic infection and idiopathic dilated cardiomyopathy, comparing samples of cases with IDCM with paired controls with Chagas-type specific dilated cardiomyopathy and ischemic-type specific dilated cardiomyopathy. Only 2.9% (1/34) of IDCM patients were HCV carriers, which strongly argue against this hypothesis. Therefore, based on our results, there is no justification for investigating HCV in patients with idiopathic dilated cardiomyopathy diagnosis.

Um quadro histopatológico similar de hepatite fatal, associado a mudanças adiposas agudas, muito espalhadas em hepatócitos e necrose unicelular, foi visto em casos epidêmicos ocorrendo em duas diferentes áreas equatoriais, com alta prevalência de infecções HBV e HDV. Os casos foram previamente considerados como sendo duas entidades diferentes: hepatite de Labrea no Brasil e hepatite de Bangui na República da Africa Central. Contudo, os achados histopatológicos sugerem que são patogênica e etiologicamente relacionados a infecções HBV e HDV, provavelmente modificados por algum fator ainda desconhecido, presente nas zonas de floresta equatorial.

A similar histopathologic picture of fatal hepatitis associated with widespread acute fatty changes in hepatocytes and single-cell necrosis was seen in epidemic cases occurring in two distinct equatorial areas having high prevalences of HBV and HDV infections. The cases were previously considered to be two different entities; Labrea hepatitis in Brazil, and Bangui hepatitis in the Central African Republic. However, the histopathologic findings suggest that they are pathogenetically and etiologically related to HBVand HDV infections, probably modified by some as yet unknown factor (s) present in equatorial forest zones.