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Autoimmune hepatitis triggered by acute hepatitis A.

Hiroto Tanaka1, Hiroto Tujioka, Hiroki Ueda

  • 13(rd) Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-0015, Japan. h-tana@yf6.so-net.ne.jp

World Journal of Gastroenterology
|November 8, 2005
PubMed
Summary

This case study highlights autoimmune hepatitis (AIH) triggered by acute hepatitis A (HA) infection. Prompt diagnosis and treatment, including plasma exchange and steroids, were crucial for patient recovery.

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Area of Science:

  • Hepatology
  • Immunology
  • Infectious Diseases

Background:

  • Autoimmune hepatitis (AIH) is a chronic liver disease characterized by immune-mediated liver inflammation.
  • Hepatitis A (HA) is an acute viral infection that typically resolves spontaneously.

Observation:

  • A 57-year-old woman presented with severe acute hepatitis, initially diagnosed as HA.
  • Elevated anti-nuclear antigen (ANA) and immunoglobulin G (IgG) levels raised suspicion for concurrent AIH.
  • Liver biopsy confirmed acute hepatitis with mild chronic inflammation.

Findings:

  • The patient responded to plasma exchange and steroid therapy, with normalization of liver enzymes (AST, ALT).
  • Recurrence of elevated liver enzymes after steroid cessation led to a re-diagnosis of AIH.

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  • A second liver biopsy confirmed AIH, and steroid therapy was reinstituted, leading to normalization of liver enzymes.

    • Implications:

    • This case suggests that acute HA can potentially trigger or unmask underlying AIH.
    • Early detection of AIH markers in patients with severe acute hepatitis is important.
    • Management requires a tailored approach, potentially involving immunosuppressive therapy for AIH.