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Atypical presentations of autoimmune hepatitis (AIH)
Abstracts
JOURNAL OF CLINICAL AND EXPERIMENTAL HEPATOLOGY
21st Annual Conference of Indian National Association for the Study of Liver (INASL), March 22–24, 2013 Hyderabad International Convention Centre, Hyderabad, India
AUTOIMMUNE HEPATITIS AND CHOLESTATIC LIVER DISEASE
Dinesh Jothimani, Olithselvan, J. Vargese, Vivekanandan, N. Gomathy, Rajasekhar, Srinivas, Cherian, Mohamed Rela Global Hospitals, Chennai, India
Case 1: A 49 year old lady presented with 4 months of jaundice, encephaolpathy, ascties and ankle oedema. Her blood results are shown in the Table 1. ANA was 1: 320, SMA negative, IgG 25.6 mg/dl. A CT abdomen showed contracted liver, moderate ascites and normal spleen. A liver biopsy showed AIH with collapse of reticulin plate, no cirrhosis.. This is a subacute liver failure due to AIH. Case 2: A 42 year old man had 2 days of fever, vomiting followed by jaundice. He became drowsy, and was shifted to our hospital. His blood tests are shown in Table 1. His Hepatitis E IgM was positive. Autoantibodies were negative. With conservative management his encephalopathy and biochemical parameters improved. Six weeks after his initial presentation bilirubin increased to 22.7 mg/dl with ALT 229, AST 313. A repeat autoantibody screen showed ANA 1:100. A liver biopsy showed lymphocytic portal tract inflammation, intracellular cholestasis with apoptosis. He was monitored for a month with rather worseining LFTs. This is acute liver failure due to Hepatitis E virus infection, triggering AIH. Case 3: A 41 year old lady developed poor appetite, jaundice and pruritus in 2009. Investigations elsewhere showed cholestastic jaundice. Her ANA 1:12560 and AMA 1:100.
Corresponding author. Dinesh Jothimani. E-mail: [email protected]
CHRONIC CHOLESTATIC DISORDERS (NON VIRAL, NON ALCOHOLIC): CLINICAL, BIOCHEMICAL, HISTOLOGICAL & RADIOLOGICAL PROFILE Ghulam NabiYattoo, Shah Ahtisham, Showkat Ali Zargar, GulJavid, Yasin Mujoo, Shaheen Parveen, Shaheen Nazir Department of Gastroenterology, SKIMS Soura, Srinagar, India
Background and Objectives: Chronic intrahepatic cholestasis includes disorders of the hepatic ductal system of varied etiologies; autoimmune, genetic, infiltrative, drugs etc. The spectrum of these disorders has not been reported
Table 1 Case 1
Case 2
Case 3
October 2012
December 2012
August 2012
Jan 2013
Sep 2012
Dec2012
AST
128
29
2921
138
63
21
ALT
77
38
4000
164
51
18
Bilirubin
18.6
0.67
21
10.6
1.8
1.6
Albumin
1.6
2.7
3.3
2.6
3
3
INR
2.8
1.4
4.4
1.1
1.07
1.0
ALP
82
93
321 (normal 130)
290 (normal 280)
GGT
36
82
362
300
© 2013, INASL
Journal of Clinical and Experimental Hepatology | March 2013 | Vol. 3 | No. 1S | S33–S36
Autoimmune Hepatitis and Cholestatic Liver Disease
ATYPICAL PRESENTATIONS OF AUTOIMMUNE HEPATITIS (AIH)
Follwing a liver biospy steroids, azathioprine and ursodeoxycholic acid was commenced. However the former 2 drugs were stopped because of osteoporotic fracture left foot and leucopenia, respectively. A repeat liver biopsy in 2012 showed cirrhosis due to PBC & AIH overlap syndrome. She was referred to our hospital for further management. Her blood tests are outlined in the table. Review of biopsy confirmed above findings.All these patients received corticosteroids with good improvement in clinical condition. Conclusion: AIH presentation may vary substantially as described above. AIH should be borne in mind when the clinical scenario not fully explained by a single disease.
JOURNAL OF CLINICAL AND EXPERIMENTAL HEPATOLOGY
21st Annual Conference of Indian National Association for the Study of Liver (INASL), March 22–24, 2013 Hyderabad International Convention Centre, Hyderabad, India
AUTOIMMUNE HEPATITIS AND CHOLESTATIC LIVER DISEASE
Dinesh Jothimani, Olithselvan, J. Vargese, Vivekanandan, N. Gomathy, Rajasekhar, Srinivas, Cherian, Mohamed Rela Global Hospitals, Chennai, India
Case 1: A 49 year old lady presented with 4 months of jaundice, encephaolpathy, ascties and ankle oedema. Her blood results are shown in the Table 1. ANA was 1: 320, SMA negative, IgG 25.6 mg/dl. A CT abdomen showed contracted liver, moderate ascites and normal spleen. A liver biopsy showed AIH with collapse of reticulin plate, no cirrhosis.. This is a subacute liver failure due to AIH. Case 2: A 42 year old man had 2 days of fever, vomiting followed by jaundice. He became drowsy, and was shifted to our hospital. His blood tests are shown in Table 1. His Hepatitis E IgM was positive. Autoantibodies were negative. With conservative management his encephalopathy and biochemical parameters improved. Six weeks after his initial presentation bilirubin increased to 22.7 mg/dl with ALT 229, AST 313. A repeat autoantibody screen showed ANA 1:100. A liver biopsy showed lymphocytic portal tract inflammation, intracellular cholestasis with apoptosis. He was monitored for a month with rather worseining LFTs. This is acute liver failure due to Hepatitis E virus infection, triggering AIH. Case 3: A 41 year old lady developed poor appetite, jaundice and pruritus in 2009. Investigations elsewhere showed cholestastic jaundice. Her ANA 1:12560 and AMA 1:100.
Corresponding author. Dinesh Jothimani. E-mail: [email protected]
CHRONIC CHOLESTATIC DISORDERS (NON VIRAL, NON ALCOHOLIC): CLINICAL, BIOCHEMICAL, HISTOLOGICAL & RADIOLOGICAL PROFILE Ghulam NabiYattoo, Shah Ahtisham, Showkat Ali Zargar, GulJavid, Yasin Mujoo, Shaheen Parveen, Shaheen Nazir Department of Gastroenterology, SKIMS Soura, Srinagar, India
Background and Objectives: Chronic intrahepatic cholestasis includes disorders of the hepatic ductal system of varied etiologies; autoimmune, genetic, infiltrative, drugs etc. The spectrum of these disorders has not been reported
Table 1 Case 1
Case 2
Case 3
October 2012
December 2012
August 2012
Jan 2013
Sep 2012
Dec2012
AST
128
29
2921
138
63
21
ALT
77
38
4000
164
51
18
Bilirubin
18.6
0.67
21
10.6
1.8
1.6
Albumin
1.6
2.7
3.3
2.6
3
3
INR
2.8
1.4
4.4
1.1
1.07
1.0
ALP
82
93
321 (normal 130)
290 (normal 280)
GGT
36
82
362
300
© 2013, INASL
Journal of Clinical and Experimental Hepatology | March 2013 | Vol. 3 | No. 1S | S33–S36
Autoimmune Hepatitis and Cholestatic Liver Disease
ATYPICAL PRESENTATIONS OF AUTOIMMUNE HEPATITIS (AIH)
Follwing a liver biospy steroids, azathioprine and ursodeoxycholic acid was commenced. However the former 2 drugs were stopped because of osteoporotic fracture left foot and leucopenia, respectively. A repeat liver biopsy in 2012 showed cirrhosis due to PBC & AIH overlap syndrome. She was referred to our hospital for further management. Her blood tests are outlined in the table. Review of biopsy confirmed above findings.All these patients received corticosteroids with good improvement in clinical condition. Conclusion: AIH presentation may vary substantially as described above. AIH should be borne in mind when the clinical scenario not fully explained by a single disease.