Autoimmune hepatitis (HAI) is likely induced by Epstein Barr Virus (EBV) infection

Introduction and Objectives HAI is an immune-mediated chronic inflammatory liver condition of uncertain etiology. There are genetic factors and triggering agents such as toxicity, infections, and medications, among others. Case summary An 18-year-old woman with nausea, vomiting, abdominal pain and jaundice, positivity for Hepatitis A IgM (IGM-HAV). PCR SARS COV 2 negative, creatinine 0.56, FA 297, GGT 463, DHL 756, INR 1.4 BT 5.32, BI 2.87, BD 2.45, ALB 3.57, AST 136, ALT 135, Hb 8.9, Neutrophils 500. Hematology concludes with hemophagocytic syndrome (SH). HCV AND HBV negative, IGG 1560, ANTI DNA 108, ANA 1:80, IGM-HAV reactive, EBV 29.9125 copies/ml. Cyclosporine is administered by SH. 10 months after she is assessed in the liver clinic for the persistence of transaminasemia. By ultrasound hepatosplenomegaly, without dilation of the bile duct. Liver biopsy reported inflammatory infiltrate of periportal predominance with interface activity, macrovesicular steatosis, without fibrosis, without hemophagocytosis, with biochemical and histological data compatible with HAI with a simplified score of 7 points. (Fig. 1). Discussion HAI is associated with positive autoantibodies, hypergammaglobulinemia and necro inflammatory features in histology. HAV and EBV can induce HAI, as it induces autologous antibodies against triose phosphate isomerase. The patient has complicated EBV infection with SH and persistence of IGM-HAV for 11 months. Liver biopsy with autoimmune hepatitis data, probably as a result of EBV infection and false positive for IgM-HAV for EBV coinfection. Conclusion A woman with EBV, probable false-positive HAV and EBV-induced HAI is reported. Funding The resources used in this study were from the hospital without any additional financing Declaration of interest The authors declare no potential conflicts of interest.

Multisystemic inflammatory syndrome related to COVID-19, with latent tuberculosis in bone marrow, and satisfactory response to tocilizumab, in a 7-year-old boy.

Paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS) or multisystem inflammatory syndrome in children (MIS-C) is a new acute-onset systemic inflammatory disease, which mainly affects children. Latent tuberculosis infection (LTBI) is characterized by the presence of immune sensitization to Mycobacterium tuberculosis (MTB) in the absence of any clinical or radiological evidence of active disease. We present a child with MIS-C related to COVID-19, with latent TB in the bone marrow, and satisfactory response to tocilizumab. It is important to pay attention in the investigation of TB cases in countries with a high prevalence of tuberculosis, especially when opting for immunusuppression.