[Chronic active hepatitis: recurrence after long-term immunosuppressive therapy in spite of normal liver histology]

We report the case of a patient with liver-kidney microsomal antibody (LKM) positive chronic active hepatitis (CAH) which was followed-up for 12 years. Besides LKM the patient's serum was positive for thyroid microsomal antibodies, but negative for antinuclear, liver membrane and smooth muscle antibodies as well as hepatitis B virus markers. The patient was HLA B 8 negative. The disease of the 23 year old female patient began as an acute hepatitis which progressed to CAH. Immuno-suppressive therapy with a combination of prednisone and azathioprine led to a long lasting normalization of transaminases, gammaglobulin levels, and finally liver histology. Despite a normal liver histology after more than six years of continuous treatment the discontinuation of therapy was followed by a relapse. The presented case with LKM-positive CAH demonstrates that discontinuation of immuno-suppressive therapy may be followed by a relapse even if normal liver histology has been achieved under treatment.