Acute iucterine hepatitis as a manifestation of severe autoimmune hepatitis

Abstract

In the article, on the example of a clinical case, a variant of the course of severe acute autoimmune hepatitis type II in a 20-year-old woman is analyzed. The prevalence of this disease are presented. Possible types of autoimmune hepatitis course are discussed. The main diagnostic criteria that indicate the likelihood of autoimmune hepatitis and the tactics of managing these patients are described.

This clinical case demonstrates that in the absence of epidemiological, anamnestic data indicating a possible viral or toxic liver damage, it is necessary to think and exclude autoimmune liver damage. It is believed that the level of gamma globulin exceeding more than 1.5 times the upper limit of normal and the absence of viral hepatitis are independent predictors of the presence of autoimmune hepatitis, and the earlier immunosuppressive therapy is started, the more favorable the prognosis of the disease.

Keywords

autoimmune hepatitis / jaundice / hypergammaglobulinemia / glucocorticoid therapy

References

[1] Domerecka W, Kowalska-Kępczyńska A, Michalak А, et al. Etiopathogenesis and diagnostic strategies in autoimmune hepatitis. Diagnostics (Basel). 2021;11(8):1418. DOI: 10.3390/diagnostics11081418

[2] Domerecka W., Kowalska-Kępczyńska A., Michalak А. et al. Etiopathogenesis and diagnostic strategies in autoimmune hepatitis // Diagnostics (Basel). 2021. Vol. 11, No. 8. P. 1418. DOI: 10.3390/diagnostics11081418

[3] Feld JJ, Heathcote EJ. Epidemiology of autoimmune liver disease. J Gastroenterol Hepatol. 2003;18(10):1118–1128. DOI: 10.1046/j.1440-1746.2003.03165.x

[4] Feld J.J., Heathcote E.J. Epidemiology of autoimmune liver disease // J. Gastroenterol. Hepatol. 2003. Vol. 18, No. 10. P. 1118–1128. DOI: 10.1046/j.1440-1746.2003.03165.x

[5] Werner M, Prytz H, Ohlsson B, et al. Epidemiology and the initial presentation of autoimmune hepatitis in Sweden: a nationwide study. Scand J Gastroenterol. 2008;43(10):1232–1240. DOI: 10.1080/00365520802130183

[6] Werner M., Prytz H., Ohlsson B. et al. Epidemiology and the initial presentation of autoimmune hepatitis in Sweden: a nationwide study // Scand. J. Gastroenterol. 2008. Vol. 43, No. 10. P. 1232–1240. DOI: 10.1080/00365520802130183

[7] Ngu JH, Bechly K, Chapman BA, et al. Population-based epidemiology study of autoimmune hepatitis: a disease of older women? J Gastroenterol Hepatol. 2010;25(10):1681–1686. DOI: 10.1111/j.1440-1746.2010.06384.x

[8] Ngu J.H., Bechly K., Chapman B.A. et al. Population-based epidemiology study of autoimmune hepatitis: a disease of older women? // J. Gastroenterol. Hepatol. 2010. Vol. 25, No. 10. P. 1681–1686. DOI: 10.1111/j.1440-1746.2010.06384.x

[9] Delgado J-S, Vodonos A, Malnick S, et al. Autoimmune hepatitis in southern Israel: a 15-year multicenter study. J Dig Dis. 2013;14(11):611–618. DOI: 10.1111/1751-2980.12085

[10] Delgado J.-S., Vodonos A., Malnick S. et al. Autoimmune hepatitis in southern Israel: a 15-year multicenter study // J. Dig. Dis. 2013. Vol. 14, No. 11. P. 611–618. DOI: 10.1111/1751-2980.12085

[11] Van Gerven NMF, Verwer BJ, Witte BI, et al. Epidemiology and clinical characteristics of autoimmune hepatitis in the Netherlands. Scand J Gastroenterol. 2014;49(10):1245–1254. DOI: 10.3109/00365521.2014.946083

[12] Van Gerven N.M.F., Verwer B.J., Witte B.I. et al. Epidemiology and clinical characteristics of autoimmune hepatitis in the Netherlands // Scand. J. Gastroenterol. 2014. Vol. 49, No. 10. P. 1245–1254. DOI: 10.3109/00365521.2014.946083

[13] Komori A. Recent updates on the management of autoimmune hepatitis. Clin Mol Hepatol. 2021;27(1):58–69. DOI: 10.3350/cmh.2020.0189

[14] Komori A. Recent updates on the management of autoimmune hepatitis // Clin. Mol. Hepatol. 2021. Vol. 27, No. 1. P. 58–69. DOI: 10.3350/cmh.2020.0189

[15] Sucher E, Sucher R, Gradistanac T, et al. Autoimmune hepatitis – immunologically triggered liver pathogenesis – diagnostic and therapeutic strategies. J Immunol Res. 2019;2019:9437043. DOI: 10.1155/2019/9437043

[16] Sucher E., Sucher R., Gradistanac T. et al. Autoimmune hepatitis – immunologically triggered liver pathogenesis – diagnostic and therapeutic strategies // J. Immunol. Res. 2019. Vol. 2019. P. 9437043. DOI: 10.1155/2019/9437043

[17] Mack CL, Adams D, Assis DN, et al. Diagnosis and management of autoimmune hepatitis in adults and children: 2019 Practice Guidance and Guidelines from the American Association for the Study of Liver Diseases. Hepatology. 2020;72(2):671–722. DOI: 10.1002/hep.31065

[18] Mack C.L., Adams D., Assis D.N. et al. Diagnosis and management of autoimmune hepatitis in adults and children: 2019 Practice Guidance and Guidelines from the American Association for the Study of Liver Diseases // Hepatology. 2020. Vol. 72, No. 2. P. 671–722. DOI: 10.1002/hep.31065

[19] Kessler WR, Cummings OW, Eckert G, et al. Fulminant hepatic failure as the initial presentation of acute autoimmune hepatitis. Clin Gastroenterol Hepatol. 2004;2(7):625–631. DOI: 10.1016/s1542-3565(04)00246-0

[20] Kessler W.R., Cummings O.W., Eckert G. et al. Fulminant hepatic failure as the initial presentation of acute autoimmune hepatitis // Clin. Gastroenterol. Hepatol. 2004. Vol. 2, No. 7. P. 625–631. DOI: 10.1016/s1542-3565(04)00246-0

[21] Hennes EM, Zeniya M, Czaja AJ, et al. Simplified criteria for the diagnosis of autoimmune hepatitis. Hepatology. 2008;48:169–176. DOI: 10.1002/hep.22322

[22] Hennes E.M., Zeniya M., Czaja A.J. et al. Simplified criteria for the diagnosis of autoimmune hepatitis // Hepatology. 2008. Vol. 48. P. 169–176. DOI: 10.1002/hep.22322

[23] Rigopoulou EI, Smyk DS, Matthews CE, et al. Epstein-barr virus as a trigger of autoimmune liver diseases. Adv Virol. 2012;2012:987471. DOI: 10.1155/2012/987471

[24] Rigopoulou E.I., Smyk D.S., Matthews C.E. et al. Epstein-barr virus as a trigger of autoimmune liver diseases // Adv. Virol. 2012. Vol. 2012. P. 987471. DOI: 10.1155/2012/987471

[25] Alvarez F, Berg PA, Bianchi FB, et al. International Autoimmune Hepatitis Group Report: review of criteria for diagnosis of autoimmune hepatitis. J Hepatol. 1999;31(5):929–938. DOI: 10.1016/s0168-8278(99)80297-9

[26] Alvarez F., Berg P.A., Bianchi F.B. et al. International Autoimmune Hepatitis Group Report: review of criteria for diagnosis of autoimmune hepatitis // J. Hepatol. 1999. Vol. 31, No. 5. P. 929–938. DOI: 10.1016/s0168-8278(99)9

[27] EASL Clinical Practice Guidelines: Autoimmune hepatitis. J Hepatol. 2015;63(4):971–1004. DOI: 10.1016/j.jhep.2015.06.030

[28] EASL Clinical Practice Guidelines: Autoimmune hepatitis // J. Hepatol. 2015. Vol. 63, No. 4. P. 971–1004. DOI: 10.1016/j.jhep.2015.06.030

RIGHTS & PERMISSIONS

Eco-Vector