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Autoimmune hepatitis and primary biliary cholangitis overlap syndrome after COVID-19
Cunha-Silva, Marlone; França, Eloy Vianey Carvalho de; Greca, Raquel Dias; Mazo, Daniel Ferraz de Campos; Costa, Larissa Bastos Eloy da; Moraes, Priscilla Brito Sena de; Veiga, Clauber Teles; Assis-Mendonça, Guilherme Rossi; Boin, Ilka de Fátima Santana Ferreira; Stucchi, Raquel Silveira Bello; Sevá-Pereira, Tiago.
  • Cunha-Silva, Marlone; Universidade Estadual de Campinas. School of Medical Sciences. Centro de Diagnóstico de Doenças do Aparelho Digestivo (GASTROCENTRO). Campinas. BR
  • França, Eloy Vianey Carvalho de; Universidade Estadual de Campinas. School of Medical Sciences. Centro de Diagnóstico de Doenças do Aparelho Digestivo (GASTROCENTRO). Campinas. BR
  • Greca, Raquel Dias; Universidade Estadual de Campinas. School of Medical Sciences. Centro de Diagnóstico de Doenças do Aparelho Digestivo (GASTROCENTRO). Campinas. BR
  • Mazo, Daniel Ferraz de Campos; Universidade Estadual de Campinas. School of Medical Sciences. Centro de Diagnóstico de Doenças do Aparelho Digestivo (GASTROCENTRO). Campinas. BR
  • Costa, Larissa Bastos Eloy da; Universidade Estadual de Campinas. School of Medical Sciences,. Department of Pathology. Campinas. BR
  • Moraes, Priscilla Brito Sena de; Universidade Estadual de Campinas. School of Medical Sciences. Centro de Diagnóstico de Doenças do Aparelho Digestivo (GASTROCENTRO). Campinas. BR
  • Veiga, Clauber Teles; Universidade Estadual de Campinas. School of Medical Sciences. Centro de Diagnóstico de Doenças do Aparelho Digestivo (GASTROCENTRO). Campinas. BR
  • Assis-Mendonça, Guilherme Rossi; Universidade Estadual de Campinas. School of Medical Sciences,. Department of Pathology. Campinas. BR
  • Boin, Ilka de Fátima Santana Ferreira; Universidade Estadual de Campinas. School of Medical Sciences. Department of Surgery. Campinas. BR
  • Stucchi, Raquel Silveira Bello; Universidade Estadual de Campinas. School of Medical Sciences. Department of Internal Medicine, Division of Infectious Diseases. Campinas. BR
  • Sevá-Pereira, Tiago; Universidade Estadual de Campinas. School of Medical Sciences. Centro de Diagnóstico de Doenças do Aparelho Digestivo (GASTROCENTRO). Campinas. BR
Autops. Case Rep ; 13: e2023422, 2023. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1420277
ABSTRACT
ABSTRACT COVID-19 is commonly associated with high serum levels of pro-inflammatory cytokines, and the post-infection status can disturb self-tolerance and trigger autoimmune responses. We are reporting a 45-year-old male who was admitted with fatigue, jaundice, elevated liver enzymes (with cholestatic pattern), and acute kidney injury two weeks after recovering from a mild SARS-CoV-2 infection. Serologies for viral hepatitis and anti-mitochondrial antibody were negative, while anti-nuclear and anti-smooth muscle antibodies were positive. There were no signs of chronic liver disease, and a magnetic resonance cholangiography showed no dilatation of biliary ducts. Histologic evaluation of the liver evidenced numerous foci of lobular necrosis without ductopenia or portal biliary reaction. Considering the autoantibody profile and histologic changes, the medical team started oral prednisone, but there was a suboptimal biochemical response in the outpatient follow-up. Two months later, a second liver biopsy was performed and revealed non-suppurative destructive chronic cholangitis, extensive areas of confluent necrosis with hepatocytes regenerating into pseudorosettes, and numerous plasma cells. According to the Paris Criteria, the patient was then diagnosed with an autoimmune hepatitis-primary biliary cholangitis overlap syndrome (AIH-PBC-OS). After adding azathioprine and ursodeoxycholic acid to the treatment, there was a satisfactory response. This is the second worldwide report of an AIH-PBC-OS triggered by COVID-19, but the first case with a negative anti-mitochondrial antibody. In this setting, histologic evaluation of the liver by an experienced pathologist is a hallmark of achieving the diagnosis and correctly treat the patient.


Full text: Available Index: LILACS (Americas) Language: English Journal: Autops. Case Rep Journal subject: Anatomia / Patologia Cl¡nica / Patologia Legal Year: 2023 Type: Article Affiliation country: Brazil Institution/Affiliation country: Universidade Estadual de Campinas/BR

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Full text: Available Index: LILACS (Americas) Language: English Journal: Autops. Case Rep Journal subject: Anatomia / Patologia Cl¡nica / Patologia Legal Year: 2023 Type: Article Affiliation country: Brazil Institution/Affiliation country: Universidade Estadual de Campinas/BR