Concurrent hepatitis B and autoimmune hepatitis a rare presentation of acute liver failure: a case report
Keywords:Acute liver failure, Autoimmune hepatitis, Chronic hepatitis B
Acute liver failure with concurrent Hepatitis b and autoimmune hepatitis is an extremely rare case. We report a 25 year female presenting to our emergency with fatigue and somnolence, distention of abdomen, jaundice, melena and increased hair loss leading to alopecia. Physical examination revealed jaundice, an enlarged liver, ascites and tenderness of upper right abdomen. Laboratory tests revealed an increased level, bilirubin, GGT, increased INR and prothrombin time with elevated IgG levels, and the presence of anti-smooth muscle antibodies, Anti-nuclear antibodies and HBV infection markers. The patient was diagnosed with liver failure resulting from chronic active hepatitis B with an autoimmune component. The treatment consisted of steroids, azathioprine, vitamin K, low-protein diet and lactulose enemas. After undergoing a molecular test (HBV DNA 3.23 × 10 IU/mL and HBeAg reactive), the treatment was modified by adding tenofovir disoproxil fumarate. After one month the patient was discharged in good clinical condition, with the recommendation of continued tenofovir disoproxil fumarate and prednisone. In subsequent follow-ups, no clinical deterioration or abnormal biochemical liver function test results were found.
Irshad M, Joshi YK, Acharya SK, Tandon BN. Prevalence of hepatitis B virus infection in healthy persons in North India. Natl Med J India. 1994 Sep-Oct;7(5):210-2.
Dalekos GN, Zachou K, Liaskos C, Gatselis N. Autoantibodies and defined target autoantigens in autoimmune hepatitis: an overview. Eur J Intern Med. 2002;13:293-303.
Gatselis NK, Georgiadou SP, Koukoulis GK, Tassopoulos N, Zachou K, Liaskos C, Hatzakis A et al. Clinical significance of organ- and non-organ-specific autoantibodies on the response to anti-viral treatment of patients with chronic hepatitis C. Aliment Pharmacol Ther. 2006;24:1563-73.
Cassani F, Cataleta M, Valentini P, Muratori P, Giostra F, Francesconi R, et al. Serum autoantibodies in chronic hepatitis C: comparison with autoimmune hepatitis and impact on disease profile. Hepatology. 1997;26:561-6.
Muratori P, Muratori L, Guidi M, Granito A, Susca M, Lenzi M et al. Clinical impact of non-organ-specific autoantibodies on the response to combined antiviral treatment in patients with hepatitis C. Clin Infect Dis. 2005;40:501-7.
Williams MJ, Lawson A, Neal KR, Ryder SD, Irving WL. Autoantibodies in chronic hepatitis C virus infection and their association with disease profile. J Viral Hepat. 2009;16:325-31.
Alvarez F, Berg PA, Bianchi FB. International Autoimmune hepatitis Group Report: review of criteria for diagnosis of autoimmune hepatitis. J Hepatol. 1999;31:929-38.
Fujisawa T, Sogo T, Komatsu H. Autoimmune hepatitis in childhood. Hepatol Res. 2007;37:496-500.
Michalska Z, Stalke P, Witczak-Malinowska K, Lakomy EA, Sikorska K, Radowska D et al. Autoimmune reactions in HBV and HCV. Med Sci Monit. 2001;7 Suppl 1:175-80.
Tabak F, Ozdemir F, Tabak O, Erer B, Tahan V, Ozaras R. Autoimmune hepatitis induced by the prolonged hepatitis A virus infection. Ann Hepatol. 2008;7:177-9.