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Alcoholic hepatitis: An important consideration

To the Editor: I read with keen interest the high-quality review of the pathogenesis, diagnosis, and management of alcoholic hepatitis by Dugum et al.1 They clearly emphasized the high morbidity and mortality rates associated with this condition.

An important consideration for healthcare practitioners is that the presentation of alcoholic hepatitis can mimic an infectious process, eg, presenting with fever and an elevated white blood cell count. Indeed, clinicians should be vigilant and should routinely evaluate for an underlying infection in patients with suspected alcoholic hepatitis, because patients with liver disease are immunocompromised and several problems can potentially coexist in any given patient.

Therefore, clinicians should focus on the clinical history and examination (vital signs, mental status examination, presence of ascites) and should screen for common coinfections such as urinary tract infection and pneumonia with a white blood cell count with differential and other tests. Of particular importance, patients with ascites should undergo diagnostic abdominal paracentesis,2 and empiric antimicrobial therapy for spontaneous bacterial peritonitis should be considered on a case-by-case basis.3

References
  1. Dugum M, Zein N, McCullough A, Hanouneh I. Alcoholic hepatitis: challenges in diagnosis and management. Cleve Clin J Med 2015; 82:226–236.
  2. Runyon BA. Introduction to the revised American Association for the Study of Liver Diseases Practice Guideline management of adult patients with ascites due to cirrhosis 2012. Hepatology 2013; 57:1651–1653.
  3. Lutz P, Nischalke HD, Strassburg CP, Spengler U. Spontaneous bacterial peritonitis: the clinical challenge of a leaky gut and a cirrhotic liver. World J Hepatol 2015; 7:304–314.
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Aibek E. Mirrakhimov, MD
Department of Internal Medicine, Saint Joseph Hospital, Chicago, IL

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To the Editor: I read with keen interest the high-quality review of the pathogenesis, diagnosis, and management of alcoholic hepatitis by Dugum et al.1 They clearly emphasized the high morbidity and mortality rates associated with this condition.

An important consideration for healthcare practitioners is that the presentation of alcoholic hepatitis can mimic an infectious process, eg, presenting with fever and an elevated white blood cell count. Indeed, clinicians should be vigilant and should routinely evaluate for an underlying infection in patients with suspected alcoholic hepatitis, because patients with liver disease are immunocompromised and several problems can potentially coexist in any given patient.

Therefore, clinicians should focus on the clinical history and examination (vital signs, mental status examination, presence of ascites) and should screen for common coinfections such as urinary tract infection and pneumonia with a white blood cell count with differential and other tests. Of particular importance, patients with ascites should undergo diagnostic abdominal paracentesis,2 and empiric antimicrobial therapy for spontaneous bacterial peritonitis should be considered on a case-by-case basis.3

To the Editor: I read with keen interest the high-quality review of the pathogenesis, diagnosis, and management of alcoholic hepatitis by Dugum et al.1 They clearly emphasized the high morbidity and mortality rates associated with this condition.

An important consideration for healthcare practitioners is that the presentation of alcoholic hepatitis can mimic an infectious process, eg, presenting with fever and an elevated white blood cell count. Indeed, clinicians should be vigilant and should routinely evaluate for an underlying infection in patients with suspected alcoholic hepatitis, because patients with liver disease are immunocompromised and several problems can potentially coexist in any given patient.

Therefore, clinicians should focus on the clinical history and examination (vital signs, mental status examination, presence of ascites) and should screen for common coinfections such as urinary tract infection and pneumonia with a white blood cell count with differential and other tests. Of particular importance, patients with ascites should undergo diagnostic abdominal paracentesis,2 and empiric antimicrobial therapy for spontaneous bacterial peritonitis should be considered on a case-by-case basis.3

References
  1. Dugum M, Zein N, McCullough A, Hanouneh I. Alcoholic hepatitis: challenges in diagnosis and management. Cleve Clin J Med 2015; 82:226–236.
  2. Runyon BA. Introduction to the revised American Association for the Study of Liver Diseases Practice Guideline management of adult patients with ascites due to cirrhosis 2012. Hepatology 2013; 57:1651–1653.
  3. Lutz P, Nischalke HD, Strassburg CP, Spengler U. Spontaneous bacterial peritonitis: the clinical challenge of a leaky gut and a cirrhotic liver. World J Hepatol 2015; 7:304–314.
References
  1. Dugum M, Zein N, McCullough A, Hanouneh I. Alcoholic hepatitis: challenges in diagnosis and management. Cleve Clin J Med 2015; 82:226–236.
  2. Runyon BA. Introduction to the revised American Association for the Study of Liver Diseases Practice Guideline management of adult patients with ascites due to cirrhosis 2012. Hepatology 2013; 57:1651–1653.
  3. Lutz P, Nischalke HD, Strassburg CP, Spengler U. Spontaneous bacterial peritonitis: the clinical challenge of a leaky gut and a cirrhotic liver. World J Hepatol 2015; 7:304–314.
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Cleveland Clinic Journal of Medicine - 82(6)
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Cleveland Clinic Journal of Medicine - 82(6)
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335-336
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Alcoholic hepatitis: An important consideration
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Alcoholic hepatitis: An important consideration
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