ABSTRACT
We describe the case of a patient with chronic hepatitis C (CHC) who showed a progressive increase in aminotransferase level, reaching values of aspartate aminotransferase 1723 UI/L, alanine aminotransferase 1519 UI/L and gamma-glutamyl-transpeptidase 296 with a bilirubin level of 6 mg/dL and direct bilirubin level of 4.6 mg/dL. One year previously, the patient had been diagnosed with CHC, genotype 1, and had an initial hepatitis C virus RNA load of 249,000 UI/mL. All the specific blood tests performed were negative except for antisoluble liver antigen (anti-SLA) antibodies, which were positive in two different determinations. A diagnosis of overlap syndrome CHC and autoimmune hepatitis was made. Steroid and azathioprine treatment was started with good response. The relationship between CHC and anti-SLA is not well characterized but has been described in these patients. We found no prior reports in the literature of CHC associated with positive anti-SLA in a patient with persistent acute hepatitis.
Subject(s)
Hepatitis C, Chronic/complications , Hepatitis, Autoimmune/complications , Aged , Autoantibodies/blood , Autoantigens/immunology , Biopsy, Needle , Hepatitis C Antibodies/blood , Hepatitis C, Chronic/immunology , Hepatitis C, Chronic/therapy , Hepatitis, Autoimmune/drug therapy , Hepatitis, Autoimmune/immunology , Humans , Immunosuppressive Agents/therapeutic use , Liver/immunology , Liver/pathology , Liver/virology , Liver Function Tests , Male , Treatment OutcomeABSTRACT
Describimos el caso de un paciente con hepatitis crónica C (HCC) en quien se detectó un incremento progresivo de las transaminasas que alcanzaron valores de aspartato aminotransferasa (AST) de 1.723 U/l, alanina aminotransferasa (ALT) de 1.519 U/l y gammaglutamil transpeptidasa (GGT) de 296 U/l, con un valor de bilirrubina de 6 mg/dl (la bilirrubina directa fue de 4,6 mg/dl). Entre sus antecedentes destaca el diagnóstico previo de una HCC con genotipo 1 y carga viral inicial de 249.000 U/ml. Todas las pruebas analíticas realizadas fueron negativas, a excepción de un antígeno soluble hepático (anti-SLA) positivo en 2 determinaciones consecutivas. Se estableció el diagnóstico de síndrome de superposición HCC y hepatitis autoinmune asociada a anti-SLA, por lo que se inició un tratamiento combinado con esteroides y azatioprina, con buena respuesta clínica y analítica. La relación entre la HCC y la positividad a anti-SLA ha sido escasamente estudiada, pero sí se ha descrito en estos pacientes. Sin embargo, no existe ningún caso en la bibliografía que haya comenzado en forma de hepatitis aguda sobre una HCC ya conocida, como ocurrió en el nuestro
We describe the case of a patient with chronic hepatitis C (CHC) who showed a progressive increase in aminotransferase level, reaching values of aspartate aminotransferase 1723 UI/L, alanine aminotransferase 1519 UI/L and gamma-glutamyl-transpeptidase 296 with a bilirubin level of 6 mg/dL and direct bilirubin level of 4.6 mg/dL. One year previously, the patient had been diagnosed with CHC, genotype 1, and had an initial hepatitis C virus RNA load of 249,000 UI/mL. All the specific blood tests performed were negative except for antisoluble liver antigen (anti-SLA) antibodies, which were positive in two different determinations. A diagnosis of overlap syndrome CHC and autoimmune hepatitis was made. Steroid and azathioprine treatment was started with good response. The relationship between CHC and anti-SLA is not well characterized but has been described in these patients. We found no prior reports in the literature of CHC associated with positive anti-SLA in a patient with persistent acute hepatitis
Subject(s)
Male , Aged , Humans , Hepatitis C, Chronic/complications , Hepatitis, Autoimmune/complications , Autoantibodies/blood , Autoantigens/immunology , Biopsy, Needle , Hepatitis C Antibodies/blood , Hepatitis C, Chronic/immunology , Hepatitis C, Chronic/therapy , Hepatitis, Autoimmune/drug therapy , Hepatitis, Autoimmune/immunology , Immunosuppressive Agents/therapeutic use , Liver/immunology , Liver/pathology , Liver/virology , Treatment Outcome , Liver Function TestsSubject(s)
Diverticulum/diagnosis , Duodenal Diseases/diagnosis , Pancreatitis/diagnosis , Abscess/diagnostic imaging , Abscess/therapy , Aged , Diagnosis, Differential , Diverticulum/therapy , Duodenal Diseases/therapy , Female , Humans , Pancreatitis/therapy , Tomography, X-Ray Computed , Treatment OutcomeSubject(s)
Diarrhea/etiology , Gastrointestinal Hemorrhage/etiology , Herpesvirus 4, Human/isolation & purification , Infectious Mononucleosis/complications , Adult , Colonoscopy , Diarrhea/diagnosis , Diarrhea/therapy , Gastrointestinal Hemorrhage/diagnosis , Gastrointestinal Hemorrhage/therapy , Humans , Infectious Mononucleosis/diagnosis , Infectious Mononucleosis/therapy , Lymphocytes/pathology , Male , Rectum/pathology , Treatment OutcomeABSTRACT
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Subject(s)
Aged , Female , Humans , Tomography, X-Ray Computed , Treatment Outcome , Pancreatitis , Duodenal Diseases , Diverticulum , Diagnosis, Differential , Abscess , PancreatitisABSTRACT
We describe the case of a 27-year-old man who presented acute hepatitis due to hepatitis A virus infection. Over the following weeks he consistently presented elevated transaminase levels and jaundice. Antinuclear and anti-smooth muscle antibodies, hypergammaglobulinemia and periportal necrosis were detected in the liver biopsy. The patient was diagnosed with autoimmune hepatitis and responded well to treatment with immunosuppressive drugs. This case, as well as other published reports, suggest that in certain individuals, acute hepatitis A may be the decisive factor leading to autoimmune hepatitis.
