Histological changes after the use of mycophenolate mofetil in autoimmune hepatitis

Corticosteroids and azathioprine are considered standard treatment for autoimmune hepatitis. There are, however, well-known systemic side effects that may preclude continuation with these immunosuppressive therapies, and small trials of the anti-metabolite mycophenolate mofetil have been reported. We report liver biopsy findings in a follow-up biopsy of a patient who had been switched from azathioprine to mycophenolate mofetil for treatment of presumed, steroid-responsive autoimmune hepatitis. Both cytoplasmic features of adaptation and nuclear alterations were noted in hepatocytes. Possible mechanisms for these findings are discussed.