Autoimmune hepatitis triggered by acute hepatitis A

Abstract

The patient was a 57-year-old woman presenting with jaundice as the chief complaint. She began vomiting on July 10, 2003. Jaundice was noted and admitted to our hospital for thorough testing. Tests on admission indicated severe hepatitis, based on: aspartate aminotransferase (AST), 1 076 IU/L; alanine aminotransferase (ALT), 1 400 IU/L; total bilirubin (TB), 20.9 mg/dL; and prothrombin time rate (PT%), 46.9%. Acute hepatitis A (HA) was diagnosed based on negative hepatitis B surface antigen and hepatitis C virus RNA and positive immunoglobulin (Ig) M HA antibody, but elevation of anti-nuclear antigen (X320) and IgG (3 112 mg/dL) led to suspicion of autoimmune hepatitis (AIH). Plasma exchange was performed for 3 d from July 17, and steroid pulse therapy was performed for 3 d starting on July 18, followed by oral steroid therapy. Liver biopsy was performed on August 5, and the results confirmed acute hepatitis and mild chronic inflammation. Levels of AST and ALT normalized, so dose of oral steroid was markedly reduced. Steroid therapy was terminated after 4 mo, as the patient had glaucoma. Starting 3 mo after cessation of steroid therapy, levels of AST and ALT began to increase again. Another liver biopsy was performed and AIH was diagnosed based on serum data and biopsy specimen. Oral steroid therapy was reinitiated. Levels of AST and ALT again normalized. The present case was thus considered to represent AIH triggered by acute HA.

HLA DRB1*13 as a Risk Factor for Type 1 Autoimmune Hepatitis in North American Patients

“…Numbers in parentheses are percentages [27][28][29]. Our finding suggests that HLA DRB1*13 in North American patients may favor the presentation of antigens that are less common or that are presented less optimally than the antigens presented by HLA DRB1*03 and DRB1*04.…”

Transitioning from Idiopathic to Explainable Autoimmune Hepatitis

“…Multiple viruses have been implicated as causes of autoimmune hepatitis, including the hepatitis A virus [108,[144][145][146][147], hepatitis B virus [148], hepatitis C virus [149][150][151], measles virus [152,153], varicella zoster virus [154], and Epstein-Barr virus [155][156][157]. These case reports have supported hypotheses about the causal relationship between viral infection and autoimmune hepatitis based mainly on molecular mimicry [158][159][160][161].…”

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.…”