Fahad M Khan1, Joseph Alcorn, Joshua Hanson. 1. Division of Gastroenterology and Hepatology, Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA, Fahadkhan527@gmail.com.
Abstract
BACKGROUND: Idiopathic painless jaundice with significant elevations in serum transaminases, occurring in a previously healthy patient, invokes a circumscribed set of possibilities including viral hepatitis, auto-immune hepatitis (AIH) and drug-induced liver injury (DILI). METHODS: In this described case, common causes of cholestatic jaundice were considered including drug-induced liver injury, viral causes of hepatitis, and auto-immune antibodies. Biliary obstruction was excluded by appropriate imaging studies. Liver biopsy was obtained, though not definitive. RESULTS: After detailed investigation failed to reveal a cause of the jaundice, an empiric trial of steroids was initiated on the possibility that our patient had antibody-negative AIH and not DILI, with an associated grave prognosis. CONCLUSIONS: Empiric treatment with prednisone led to rapid resolution of jaundice and to the conclusion that the correct diagnosis was antibody-negative AIH.
BACKGROUND:Idiopathic painless jaundice with significant elevations in serum transaminases, occurring in a previously healthy patient, invokes a circumscribed set of possibilities including viral hepatitis, auto-immune hepatitis (AIH) and drug-induced liver injury (DILI). METHODS: In this described case, common causes of cholestatic jaundice were considered including drug-induced liver injury, viral causes of hepatitis, and auto-immune antibodies. Biliary obstruction was excluded by appropriate imaging studies. Liver biopsy was obtained, though not definitive. RESULTS: After detailed investigation failed to reveal a cause of the jaundice, an empiric trial of steroids was initiated on the possibility that our patient had antibody-negative AIH and not DILI, with an associated grave prognosis. CONCLUSIONS: Empiric treatment with prednisone led to rapid resolution of jaundice and to the conclusion that the correct diagnosis was antibody-negative AIH.
Authors: Laura Donaghy; Fergus J Barry; Jeremy G Hunter; William Stableforth; Iain A Murray; Jo Palmer; Richard P Bendall; Ahmed M Elsharkawy; Harry R Dalton Journal: Eur J Gastroenterol Hepatol Date: 2013-10 Impact factor: 2.566
Authors: Timothy J Davern; Naga Chalasani; Robert J Fontana; Paul H Hayashi; Petr Protiva; David E Kleiner; Ronald E Engle; Hanh Nguyen; Suzanne U Emerson; Robert H Purcell; Hans L Tillmann; Jiezhun Gu; Jose Serrano; Jay H Hoofnagle Journal: Gastroenterology Date: 2011-08-16 Impact factor: 22.682