P21 | A case of acute hepatitis: does therapy lead to a diagnosis?
Year: 2025
Type: article
Study design: Case Report
Abstract: Premises: Autoimmune hepatitis is a rare and heterogeneous disease in terms of clinical presentation. The diagnosis can be made in the advanced chronic or acute phase. Immunosuppressive therapy can induce complete remission, but it also serves as an important ex adiuvantibus criterion in diagnosis.Clinical Case Description: A 49-year-old patient underwent blood tests, which incidentally revealed elevated transaminases (AST 85 U/L, ALT 111 U/L). A negative diagnostic process for viral hepatitis began, with negative abdominal ultrasound and CT scan results. Following a further increase in liver cytolysis indices and the onset of jaundice, he was admitted to the emergency room. During hospitalization: AST 1578, ALT 1317, total bilirubin 18.3, GGT 180, ALP 270, hypergammaglobulinemia. Testing for major (HAV, HEV, HBV, HCV) and minor (EBV, CMV, HSV 1 and 2) hepatitis viruses was negative. The abdominal MRI documented hepatomegaly and signs of acute inflammation. Autoimmunity: ANA positive 1:160 homogeneous pattern, AMA/ASMA/ENA negative, liver immunoblot negative. He performed a liver biopsy and started prednisone 50 mg/day while awaiting the results. After 4 days of therapy, a marked reduction in liver cytolysis indices was observed: AST 757, ALT 919, total bilirubin 5.42, ALP 190, GGT 201.Conclusions: Autoimmune hepatitis should always be suspected in patients with hepatitis of unknown etiology. The presence of autoantibodies, hypergammaglobulinemia, and histology are the basis for diagnosis, but in cases of acute onset and a high probability of the disease, it is crucial not to delay the start of therapy.
Source: Italian Journal of Medicine
Authors: Vo Van Kha, Tran Thi Huong Ly, Pham Thi Thanh Hoa, Vo Huynh Nhu, Damas Hendriansyah, Nusratuddin Abdullah, Rudy B. Leonardy, Mardiah Tahir, Samrichard Rambulangi, Firdaus Hamid, Filomena Pietrantonio, Vera Kopsaj, Francesco Rosiello, Aurora Tomassoni, Luca Moriconi, Donatella Padua, Kiki Rizki Amelia, Efendi Lukas, Nurbani Bangsawan, Isharyah Sunarno, Retno Budiarti Farid, Sriwijaya Qadar, Rabab H. Elshaikh, Ashok Kumar Sah, Abdelrahman Mohamed Abukanna, Abdulrahman Algarni, Ammar Abdelmola, Hussam Ali Osman, Tagwa Yousif Elsayed Yousif, Elryah I. Ali, Hiba Ali, Ayman Hussein Alfeel, Thanh Long Nguyen, Victor Storm, Lam Toi Phung, Cong Thien Le, Thi Thu Ha Le, Thi Hoa Nguyen, Son Tung Vu, Thien Thang Tran, Minh Hanh Vu, Van Tuan Nguyen, Francesco Ventrella, Anna Belfiore, Antonio Greco, Franco Mastroianni, Salvatore Lenti, Domenico Ruggiero, Michele Cannone, Vincenzo Ostilio Palmieri, Massimo Errico, Giuseppe Mancia, Guido Grassi, Sverre E. Kjeldsen
Language: English
Topic: Liver Diseases and Immunity
Subfield: Hepatology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4413771908