Author/Authors :
A. Baba Hideo نويسنده Department of Pathology, University Hospital, University Duisburg Essen, Germany , Canbay Ali نويسنده Department of Gastroenterology and Hepatology, University Hospital, University Duisburg Essen, Germany , Gerken Guido نويسنده Department of Gastroenterology and Hepatology, University Hospital, University Duisburg Essen, Germany , Kahraman Alisan نويسنده Department of Gastroenterology and Hepatology, University Hospital, University Duisburg Essen, Germany , Thodou Victoria نويسنده Department of Gastroenterology and Hepatology, University
Clinic Essen, Germany , Buechter Matthias نويسنده Department of Gastroenterology and Hepatology, University
Clinic Essen, Germany , Kalsch Julia نويسنده Department of Gastroenterology and Hepatology, University
Clinic Essen, Germany
Abstract :
A 49-year-old male patient was referred to our institution for
acute liver failure (ALV). Apart from cholestasis, coagulopathy, and
hepatic encephalopathy (HE) I°, laboratory studies revealed a
significant increase in liver enzymes with an alanine aminotransferase
(ALT) level of 4’108 U/L and an aspartate aminotransferase (AST) level
of 3’878 U/l (normal < 50 U/L), a constellation essentially
compatible with autoimmune hepatitis (AIH). Work-up of serological
markers for hepatitis E (HEV-IgM and PCR) was at the same time positive.
Furthermore, the patient was strongly positive for antinuclear
autoantibodies (ANA) with a titer of 1:1’280 (normal upper limit 1:80),
and also presented hypergammaglobulinemia (immunoglobulin IgG-level of
21.3 g/L; normal 7, 0 - 16, 0 g/L). Liver histology demonstrated massive
hepatitis and necrosis with the presence of plasma cells. Due to the
diagnosis of de-novo autoimmune hepatitis, therapy with steroids was
performed despite the evidence of acute HEV-infection. It was of great
importance that the patient recovered completely while neither antiviral
therapy with ribavirin nor liver transplantation (LT) was necessary in
the further course.
