Chronic Lobular Hepatitis: A Clinicopathological and Prognostic Study

Abstract

A series of 80 patients with chronic lobular hepatitis (CLH) was reviewed clinically and histologically to demonstrate etiology, clinical presentation, course, and prognosis of this disorder. Data from our study indicate that CLH in Taiwan is a disease of viral origin, mostly hepatitis B (67.5%) and some non-A, non-B. It occurs predominantly in young males (81.3%); frequently commences as acute viral hepatitis (57.5%); and has clinical and laboratory features similar to convalescent viral hepatitis or even indistinguishable from full-blown acute viral hepatitis. Clinical and histological follow-up study indicate that CLH may extend for several years with remissions and relapses. No evidence of progression to cirrhosis was observed at least in a 4%-year period of follow-up. It is concluded that CLH is a persistent but nonprogressive disease although the number of non-A, non-B CLH is too small to ascertain its nonprogressive course. The prognosis is generally good, and no specific therapy is required.Chronic lobular hepatitis (CLH) was first proposed and described by Popper and Schaffner (1) as "acute hepatitis" lasting for longer than 3 months. Although the term CLH was not accepted by the International Association for the Study of the Liver (IASL) (2) it has repeatedly appeared in the literature not only by Popper and Schaffner (3, 4) but also by European investigators (5-8). The most recent report of an international group also adopted CLH as one form of chronic hepatitis (9).However, only a few clinical studies on small series of CLH have been documented since the term was proposed (10-12). On the other hand, chronic hepatitis has been defined by the IASL as hepatitis with a minimum duration of 6 months (2). The original definition of CLH by Popper and Schaffner (1) should be modified in time scale. It is, therefore, relevant at this time to further investigate this type of chronic hepatitis by a large series of patients. MATERIALS AND METHODSThe patients were selected by extensive clinical and pathological review from a consecutive series of patients who had been studied by liver biopsy in our Liver Unit

Chronic hepatitis B virus infection acquired in childhood: special emphasis on prognostic and therapeutic implication of delayed HBeAg seroconversion

“…This chronological sequence of HBV DNA and ALT in spontaneous acute flares is similar to that observed in acute flares secondary to therapeutic intervention with corticosteroids or cancer chemotherapy [28]. Histological evidence of acute lobular hepatitis superimposed upon the changes of chronic viral hepatitis is frequently observed during these flares [29,30]. Immunoglobulin class M antibody to HBcAg also may appear at this time, but is generally in lower titres than in acute infection [26,30].…”