Is simultaneous presence of IgG4-positive plasma cells and giant-cell hepatitis a coincidence in autoimmune hepatitis? A case report

Abstract

BACKGROUND The immune-mediated invasion of IgG4-positive plasma cells in the liver is found in some autoimmune hepatitis. Giant-cell hepatitis (GCH) is a very rare pathological feature in adults, and the clinical characteristics of the simultaneous appearance of the two pathological phenomena are not clear. CASE SUMMARY A 68-year-old woman was hospitalized with fatigue, poor appetite, and yellow urine for 20 d. Liver function tests and immunological indexes were significantly abnormal and accompanied by elevated serum IgG4 levels. Liver pathology revealed severe inflammation of the interface between the portal tract and hepatocytes, portal area inflammation, plasma cell infiltration, formation of rosette cells, IgG4-positive plasma cells > 10/high-power field, IgG4/IgG > 40%, and multinucleated liver cell swelling. IgG4-related autoimmune hepatitis (AIH) combined with GCH was diagnosed, and methylprednisolone was administered at 40 mg/day. Two weeks later, the clinical symptoms disappeared, and the liver function and immunological indicators were significantly improved. Methylprednisolone was reduced at a rate of 4–8 mg per week to 8 mg/day for maintenance. A second liver biopsy 48 wk later indicated that liver inflammation and fibrosis were significantly improved. IgG4-positive plasma cells and GCH were not detected. A literature search was conducted to analyze articles reporting similar pathological phenomena. CONCLUSION AIH with simultaneous IgG4-positive plasma cell infiltration and GCH, liver inflammation, and fibrosis is possibly more severe than typical AIH but sensitive to corticosteroids.

Post-infantile Giant Cell Hepatitis: A Literature Review and Meta-analysis

“…Most of the improvements were based on clinical and/or biochemical improvements. The reduction or elimination of giant cells, 11 , 16 , 18 , 19 , 32 , 33 , 40 decreased inflammation, 23 , 33 or even regression of fibrosis 26 was documented to a less extent.…”

“…Among the autoimmune disorders associated with PIGCH, autoimmune liver diseases were the most common, including autoimmune hepatitis (type I or II), 12,[18][19][20][21][22][23][24][25][26][27][28][29][30] primary sclerosing cholangitis, 7,31 and primary biliary cholangitis. 10 Other autoimmune conditions included systemic lupus erythematosus, 32,33 Graves' disease, 34 undifferentiated connective tissue disease, 35 and polyarteritis nodosa.…”