Korean J Gastroenterol.  2011 May;57(5):315-318. 10.4166/kjg.2011.57.5.315.

A Case of Autoimmune Hepatitis Following Acute Hepatitis A

• Kim YD
• Kim KA
• Rou WS
• Lee JS
• Song TJ
• Bae WK
• Kim NH

• KMID: 1792789
• DOI: http://doi.org/10.4166/kjg.2011.57.5.315

Abstract

The pathogenesis of autoimmune hepatitis (AIH) is unclear, but viral infections have been proposed as a potential trigger in patients with genetic predisposition. We report a case of AIH following acute hepatitis A (AHA). A 57-year-old woman presented with fatigue and pitting edema for last 3 months. She had been diagnosed as an AHA 15 months ago based on clinical features, biochemical tests and positive HAV IgM antibody at a local clinic. Her biochemical tests was normalized one month after AHA diagnosis, but the serum levels of aminotransferase started to rise four months after AHA diagnosis. Antinuclear antibody was positive at a titer of 1:40, and anti-smooth muscle antibody was also positive. Hypergammaglobulinemia and liver pathology were typical for AIH. The patients had a score of 17 according to the International Autoimmune Hepatitis Group's system. She was given prednisolone and azathioprine and showed complete response to immunosuppressive therapy. The present case is the first report on AIH triggered by AHA in Korea.

Keyword

Hepatitis A; Autoimmune hepatitis

MeSH Terms

Acute Disease
Alanine Transaminase/blood
Antibodies, Antinuclear/analysis
Aspartate Aminotransferases/blood
Autoantibodies/analysis
Azathioprine/therapeutic use
Female
Hepatitis A/complications/*drug therapy
Hepatitis, Autoimmune/*diagnosis/drug therapy/etiology
Humans
Hypergammaglobulinemia/diagnosis
Immunosuppressive Agents/therapeutic use
Liver/pathology
Middle Aged
Prednisolone/therapeutic use

Figure

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  Fig. 1. Pathologic findings of liver biopsy specimen. (A) Interface hepatitis with bridging fibrosis was observed (H&E stain, ×100). (B) Lympho-plasmacytic infiltration was also noted (H&E stain, ×400).

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