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血清阴性自身免疫性肝炎:COVID-19的一个罕见表现
Hwewon E Lee1, Julia Zhang2, Alyeesha B Wilhelm3
1Department of Internal Medicine, University of Texas Medical Branch at Galveston, Galveston, USA.
Cureus
|October 23, 2023
概括
这项案例研究突出显示了一例罕见的血清阴性自身免疫性肝炎 (AIH) 病例,该病例发生在最近感染COVID-19的患者身上. 它建议在COVID-19后的肝损伤中应考虑AIH,即使最初的自身免疫标记是负的.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 病毒学 病毒学
- 免疫学 免疫学 免疫学
背景情况:
- 严重急性呼吸道综合征冠状病毒2 (SARS-CoV-2) 感染可能导致肝功能障碍,从轻微的酶升高到肝衰竭.
- 新出现的证据表明,2019年冠状病毒病 (COVID-19) 或SARS-CoV-2疫苗接种与自身免疫性肝炎 (AIH) 的发展之间存在潜在联系.
- 自身免疫性肝炎是一种炎症性肝病,身体的免疫系统攻击肝细胞.
研究的目的:
- 在最近感染COVID-19的患者中呈现一种罕见的血清阴性自身免疫性肝炎 (AIH).
- 讨论将SARS-CoV-2感染与AIH联系起来的潜在潜在机制.
- 强调在COVID-19后肝损伤的差异诊断中考虑AIH的重要性,即使最初没有显著的自身免疫检查.
主要方法:
- 一个39岁的女性患有黄,腹痛和肝酶升高的病例介绍.
- 诊断工作包括肝功能测试,病毒性肝炎血清学,自身抗体查 (ANA,ASMA,AMA,LKM-1,SLA,ANCA),SARS-CoV-2测试和腹部成像.
- 进行了肝脏活检,揭示了具有再生变化和的活性淋巴细胞性肝炎,导致AIH的诊断.
主要成果:
- 该患者的SARS-CoV-2检测结果呈阳性,但没有呼吸系统症状,并且接种了最新的疫苗.
- 最初的自身抗体查在很大程度上是负面的,除了边界F-actin抗体水平.
- 组织病理学证实了AIH,患者在开始类固醇治疗后显示出显著的临床和生化改善.
结论:
- 这一案例表明,最近的COVID-19感染与血清阴性自身免疫性肝炎的发展之间存在潜在的关联.
- 它强调了在COVID-19后出现不明原因的肝损伤的患者中,无论最初的自身抗体结果如何,需要对AIH的高怀疑指数.
- 需要进一步的研究来阐明病毒诱导的自身免疫功能障碍的病理生理学及其对患者管理的影响.
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