Sunil Taneja1, Pramod Kumar1, Suvradeep Mitra2, Ajay Duseja1, Ranjana Minz3, Ashim Das2, Radha K Dhiman1, Yogesh Chawla1. 1. Department of Hepatology, Post Graduate Institute of Medical Education & Research, Chandigarh, India. 2. Department of Histopathology, Post Graduate Institute of Medical Education & Research, Chandigarh, India. 3. Department of Immunopathology, Post Graduate Institute of Medical Education & Research, Chandigarh, India.
Abstract
BACKGROUND: Acute exacerbation of Autoimmune Hepatitis (AIH) poses a significant challenge for diagnosis as it can mimic acute viral hepatitis especially in absence of autoantibodies and hypergammaglobulinemia. AIM: To determine the clinical, laboratory, histopathological characteristics and response to treatment in AIH patients with acute exacerbation. METHODS: A retrospective analysis of 16 patients with acute exacerbation of AIH diagnosed over a period of eight years (2008-2016). RESULTS: Out of the 111 patients diagnosed with AIH, acute exacerbation of AIH was diagnosed in 16 (14.4%) patients. All patients were females with median age of 35 years. Nine patients (56%) had Type 1 AIH and seven (44%) patients were diagnosed with seronegative AIH. All 16 (100%) patients had acute viral hepatitis like illness at presentation. The median bilirubin was 4.2 mg/dl (range, 2.2-20), aspartate transaminase was 568 IU/L (range, 390-908), alanine transaminase was 430 IU/L (range, 257-1026) and serum alkaline phosphatase was 395 IU/L (range, 112-890) during symptomatic period. The histopathological examination showed underlying chronic hepatitis in 10 (71.4%) patients, only fibrosis in 2 (14.2) patients and cirrhosis with activity in 2 (14.2%). All 16 (100%) patients were treated with a combination of steroids and azathioprine. Thirteen (81%) patients achieved complete biochemical remission and three (19%) patients achieved partial remission out of which one (6%) patient succumbed to illness because of the complications of cirrhosis. CONCLUSION: A suspicion of acute exacerbation of AIH should be considered in patients with unexplained acute hepatitis mimicking acute viral hepatitis in the absence of positive viral markers. Through evaluation with immunoserological markers and liver biopsy can clinch the diagnosis of acute exacerbation of AIH in such cases.
BACKGROUND: Acute exacerbation of Autoimmune Hepatitis (AIH) poses a significant challenge for diagnosis as it can mimic acute viral hepatitis especially in absence of autoantibodies and hypergammaglobulinemia. AIM: To determine the clinical, laboratory, histopathological characteristics and response to treatment in AIH patients with acute exacerbation. METHODS: A retrospective analysis of 16 patients with acute exacerbation of AIH diagnosed over a period of eight years (2008-2016). RESULTS: Out of the 111 patients diagnosed with AIH, acute exacerbation of AIH was diagnosed in 16 (14.4%) patients. All patients were females with median age of 35 years. Nine patients (56%) had Type 1 AIH and seven (44%) patients were diagnosed with seronegative AIH. All 16 (100%) patients had acute viral hepatitis like illness at presentation. The median bilirubin was 4.2 mg/dl (range, 2.2-20), aspartate transaminase was 568 IU/L (range, 390-908), alanine transaminase was 430 IU/L (range, 257-1026) and serum alkaline phosphatase was 395 IU/L (range, 112-890) during symptomatic period. The histopathological examination showed underlying chronic hepatitis in 10 (71.4%) patients, only fibrosis in 2 (14.2) patients and cirrhosis with activity in 2 (14.2%). All 16 (100%) patients were treated with a combination of steroids and azathioprine. Thirteen (81%) patients achieved complete biochemical remission and three (19%) patients achieved partial remission out of which one (6%) patient succumbed to illness because of the complications of cirrhosis. CONCLUSION: A suspicion of acute exacerbation of AIH should be considered in patients with unexplained acute hepatitis mimicking acute viral hepatitis in the absence of positive viral markers. Through evaluation with immunoserological markers and liver biopsy can clinch the diagnosis of acute exacerbation of AIH in such cases.
Authors: Michael P Manns; Albert J Czaja; James D Gorham; Edward L Krawitt; Giorgina Mieli-Vergani; Diego Vergani; John M Vierling Journal: Hepatology Date: 2010-06 Impact factor: 17.425
Authors: Nicole M F van Gerven; Bart J Verwer; Birgit I Witte; Karel J van Erpecum; Henk R van Buuren; Ingrid Maijers; Arjan P Visscher; Edwin C Verschuren; Bart van Hoek; Minneke J Coenraad; Ulrich H W Beuers; Robert A de Man; Joost P H Drenth; Jannie W den Ouden; Robert C Verdonk; Ger H Koek; Johannes T Brouwer; Maureen M J Guichelaar; Jan Maarten Vrolijk; Chris J J Mulder; Carin M J van Nieuwkerk; Gerd Bouma Journal: Scand J Gastroenterol Date: 2014-08-15 Impact factor: 2.423