Autoimmune liver diseases may be associated with extrahepatic autoimmune pathology. We report the case of a 52-year old woman who initially presented to the gastroenterology department for extreme fatigue, pale stools, dark urine and pruritus. Laboratory tests showed significant cholestasis and elevation of aminotransferase levels. Immunological tests revealed positive antinuclear (ANA=1:320) and antimitochondrial antibodies (AMA=1:40) with negative anti-smooth muscle and liver kidney microsomal type 1 antibodies. The biopsy was compatible with overlap syndrome type 1. The patient was commenced on immunosuppressive therapy according to standard of care (azathioprine 50mg, ursodeoxycholic acid and prednisone 0.5mg/kg), with moderate biochemical improvement. She subsequently developed proximal symmetrical weakness and cutaneous involvement and was diagnosed with biopsy-proven dermatomyositis. The immunosuppressive regimen was intensified to 150 mg azathioprine. At the three-month follow-up, her symptoms subsided and aminotransferases and muscle enzymes normalized. Upon further investigation the patient was diagnosed with autoimmune thyroiditis and antiphospholipid syndrome. To our knowledge, this is the first case of primary biliary cirrhosis - autoimmune hepatitis overlap syndrome associated with dermatomyositis, autoimmune thyroiditis and antiphospholipid syndrome.
PURPOSE:Recently new roles for vitamin K, different from that in coagulation, have been proposed, including prevention of cardiometabolic diseases. It was the aim of the present work to evaluate the impact of vitamin K treatment on the changes in liver and pancreas of rats with experimentally induced metabolic syndrome. METHODS: Four groups of rats were used, as follows: one control group fed regular rat chow; one group fed high fat, high fructose (HFHF) diet for 12 weeks to induce a metabolic syndrome (MS) and two groups with MS treated with vitamin K1 and K2 respectively. At the end of the experiment, liver tissue and pancreatic were dissected out for morphological examination. RESULTS: All groups of rats fed HFHF diet expressed liver histological changes consistent with steatosis. These alterations were more pronounced in the groups treated with vitamin K2 and K1. The pancreatic tissue of the HFHF fed animals showed similar degree of lipomatosis irrespective of treatment. CONCLUSIONS:In rats with diet-induced MS, treatment with vitamin K1 and K2 did not produce the expected morphological evidence of improvement, even tended to aggravate the liver changes. These results disagreed with other effects of vitamin K that were established.
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