Acute liver biopsy lesions in early autoimmune (“lupoid”) chronic active hepatitis

Abstract

ABSTRACT— We studied two female patients with autoimmune (“lupoid”) chronic active hepatitis whose liver biopsies at initial presentation showed the unusual features of an acute hepatitis. Centrilobular hepatocyte swelling and multinucleation, acidophilic degeneration, cholestasis, mild fatty change and bile duct damage in one case resembled lesions of non‐A, non‐B hepatitis. Lobular and portal infiltrates of plasma cells with piecemeal necrosis suggested transition to chronicity as well as an autoimmune component. This was additionally supported by the presence of hypergammaglobulinemia and auto‐antibodies in both patients. We conclude that liver biopsy features in the acute presentation of lupoid hepatitis may be difficult to distinguish from those seen in acute hepatitis due to virus or drugs.

Acute presentation of autoimmune hepatitis: a multicentre study with detailed histological evaluation in a large cohort of patients

“…To date, no standardised definition or acceptable diagnostic criteria have been established for the acute presentation of AIH, although this entity has long been recognised 10 66. Liver biopsy is crucial to diagnose AIH and guide treatment decisions.…”

Precise histological evaluation of liver biopsy specimen is indispensable for diagnosis and treatment of acute-onset autoimmune hepatitis

“…Lefkowitch et al fi rst reported AIH cases presenting histologically acute hepatitis. 19 In a Japanese nationwide survey study, 5.6% of patients with AIH were found to have a feature of acute hepatitis upon histological examination. 20 Nikias et al reported that lobular hepatitis is an important histological feature in AIH with an acute presentation.…”

Acute presentation of autoimmune hepatitis: Does it exist? A published work review

“…Lefkowitch et al . first reported two AIH cases presenting histologically acute hepatitis 1 . Abe et al .…”