Thursday, December 08, 2011

Is CFS an Undiagnosed Liver disease?

Today, they have started to see my biopsy, they still need to do more tests for the B virus, but they told me that I should not worry about my liver. There is no fibrosis there and is quite "healthy". But there is injury to the hepatocytes, but they still need to know if they are infected with hepatitis B virus, which could cause the injury.

In Pathology, they normally look at 3 parameters, in the first two I have a zero rank, which means I am okay. In the third one, which is the "hepatocyte necrosis" I rank 1 (range 1-3). So there is injury, but the liver is not really damaged as for today, therefore I have no prognosis for cirrhosis at all.

Nevertheless it could potentially explain part of my symptoms, because the liver lesion is present, but that's better to wait for the final report and the interpretation of my liver specialist.

Hepatocyte necrosis is closely linked to apoptosis (programmed cell death), and that is what I have seen in the many analysis that I have done since I fell sick in 2006:

- 2006 RNase-L, elastase and high PKR = programmed cell death -> immunity to fight against something (Redlabs-Belgium)
- 2009 free circulating DNA Very high = programmed cell death -> immunity to fight against something (Acumen-UK)
- 2010, abnormal levels of the ligands FAS = programmed cell death -> immunity to fight against something (Irsi Caixa, Barcelona)
- 2011, elevated Granzyme B = programmed cell death -> immunity to fight against something (Gregorio Marañón, Madrid)

So, apparently it does seem that whatever I have in the liver is related to my CFS history.

It was not easy at all to detect the damage in my liver:

During all these years, no wrong liver function blood standard test (2005-2011):

-All the blood work on liver enzymes came normal
-All liver function came normal (GPT/GOT)
-All B & C serologies came negative
-Even a PCR DNA on B virus came NEGATIVE! But that is because PCR has limitations in the number of copies per ml that they can detect, normally starting from 120 copies.

However, what was present in a more subliminal and less conclusive way, were these traces of other liver malfunction in "not liver exclusive link test": (2005-2011)

-Presence of ammonia in blood
-High levels of nitric oxide in blood
-frequent high levels of bilirubin in blood
-Occasional severe abdominal pain in the right upper quadrant that could last more than 8 hours, 3 times a year that I need to go to the hospital to get a pain killer in vein.
-Occasional mild jaundice
-Frequently elevated fibrinogen
-Protein C active frequently high
-Sleep inverted (cortisol inverted)
-Occasional itching
-Occasional acolia
-Occasional coluria
-Essential amino acid deficiency
-High levels of cholesterol and triglycerides
-HBc antibody-positive on three occasions, intercalated with negative results in many more occasions in the last 3 years.

In November 2011, a very sophisticated PCR technique was used to detect even a single copy of the virus per milliliter, and they found 13 copies in my case, so I was recommended a liver biopsy, which is where they have seen the damage to liver cells.

It is now clear to me that "something" has infected my hepatocytes, and that causes liver inflammation and injury.
The big question is whether it is a mutant version of hepatitis B virus in the pre-core S region, or a hidden hepatitis B virus in the liver, and that will tell me next week.

If this is confirmed, I believe many people with Chronic Fatigue Syndrome may be infected with an undiagnosed B virus that could explain at least part of the clinical symptoms they present. If that was the case, it could also explain why tenofovir therapy works in some patients with CFS.

Another possibility in many patients with CFS is a chronic autoimmune hepatitis is not my case. In autoimmune hepatitis predominantly female (78%) in the absence of virus serological markers, elevated serum levels of IgG, high titers of antibodies (ANA, SMA, anti-LKMI), and 60% have other autoimmune thyroiditis , rheumatoid arthritis, ulcerative colitis. In these cases, immunosuppressive therapy would be effective, so perhaps the work Rituximab in patients with CFS.

Bear in mind that both "autoimmune chronic hepatitis" and "chronic hepatitis by a mutan B virus of the Pre-core region" are not present in common serologies. Autoimmune hepatitis is treated with immunosupression, and chronic Hepatitis B is treated with retrovirals. That could potentially explain why Tenofovir or Rituximab have been effective in different subsets of CFS patients.


Anonymous said...

Thank you, that was very interesting.

Anonymous said...

I have been trying for years to bring to the attention of researchers and other patients the possibility that CFS=undiagnosed liver disease.In addition to liver disease caused by viruses(including herpes viruses that are associated with CFS)there are medications that cause liver damage.At least you were able to get a diagnosis.I cannot get a diagnosis and even though I am incapacitated I cannot get any financial assistance so I also have to worry about what will happen to me when my mother will no longer be around to help me.It has been a few years since your post.Did you have a tratment that worked?I am beginning to pin my hopes on genome wide association studies to point to polymorphisms that will point to the liver being involved since so far there hasnot been an interest in developping a test more effective than blood tests which cannot rule out liver disease or damage.

carlitos said...
This comment has been removed by the author.
Carlitos said...

Well, I can't conclude that my CFS was linked to my liver, because the hepatitis that I had, was not linked to A, B, C or D Viruses. All of them were ruled out by very sophisticated and sensible blood test. The B virus nevertheless was weird, because 13 copies were found, which is quite inconclusive, because the liver biopsy came clean.