Autoimmune Hepatitis – Sequel of a Relapsing Hepatitis A in a 75-Year-Old Woman

Abstract

Acute hepatitis A virus (HAV) infection is a global cause of acute hepatitis. However, chronic HAV infection is unlikely. Nevertheless, there is some evidence that acute infection with HAV may trigger chronic active hepatitis which fulfils the criteria of autoimmune hepatitis (AIH). Whether AIH following HAV infection is virus specific remains unclear. Despite evidence that inherited factors may play a role in the development of autoimmunity after viral infection, the pathomechanism remains unclear. We describe a 75-year-old woman with a history of pulmonary sarcoidosis who developed AIH after acute HAV infection.

Influence of genes, sex, age and environment on the onset of autoimmune hepatitis

“…In fact, a study showed that very few patients with AIH had specific antibodies against HCV suggesting that most of them had never encountered this virus [93] . Other hepatitis-causing viruses such as hepatitis A and B viruses (HAV, HBV) have been proposed as triggers for AIH [94][95][96][97][98] . The Epstein-Barr virus (EBV), has been associated with AIH in several case reports and in a clinical follow-up of 13 patients [66][67][68][69] .…”

“…Hepatitis A virus Case reports [94][95][96] Hepatitis B virus Case reports [97,98] Hepatitis C virus Specific AIH autoantibodies [87][88][89] Cross-Reactivity at T and B-cell level [90][91][92] Epstein-Barr virus Case reports [66][67][68][69] Human herpes virus 6 Sequence similarities [99] Herpes simplex virus Sequence similarities [102] Cross-reactivity at B-cell level [102] 1030…”

More on autoimmune hepatitis and acute hepatitis A

“…In the English literature, nine more cases of AIH [3][4][5][6][7][8][9][10][11], including our case report and a case of overlap syndrome [AIH/primary biliary cirrhosis (PBS)] [12] developed after acute HAV infection, have been published. Besides, a case of AIH after HAV vaccination [13] and two overlap syndromes after combined vaccine of HAV and hepatitis B virus (one AIH/PBS and one AIH/primary sclerosing cholangitis) [14] were reported.…”

Successful Treatment With Corticosteroid and Lamivudine for Autoimmune Hepatitis in a Patient With Asymptomatic HBV Infection

“…Current hypotheses suggest that AIH is triggered by environmental factors, such as infectious organisms or drugs, and that molecular mimicry is invoked as a potential mechanism. In some case reports, the emergence of AIH after hepatitis A virus infection [21][22][23][24], measles virus infection [25][26][27], and EpsteinBarr virus infection [28][29][30] have been described. In Japan, the majority of patients who were diagnosed as having type 2 AIH were associated with chronic HCV infection [31].…”