A rare case of autoimmune hepatitis presented with acute onset of high fever
Makaleler > Tam Makale · 2014
Yazarlar: E. Ertem, İ.S. Ertem, Ö.B. Binicier
International Journal of Infectious Diseases, Uluslararası, Wos, 2014, cilt 21, ss 152-152
DOI: 10.1016/j.ijid.2014.03.740
Özet
Background: Autoimmune hepatitis (AIH) is a chronic autoimmune disease of the liver characterized by hyperglobulinemia, presence of autoantibodies and histological signs of chronic hepatitis in liver biopsy. There is no specific clinical sign or symptom. In 25-30% of the cases, it begins with acute symptoms and high transaminase values mimicking mostly an infectious process. We present a rare case of autoimmune hepatitis which became manifest by only the acute rise of fever. Methods & Materials: Thirty four year old female patient had the complaint of high fever for the last 10 days. There was no physical sign or symptom. CRP and sedimentation values were high and other results were; ALT 129 U/L, AST 78 U/L, Albumin 3.3 gr/dl, Globulin 3.7 gr/dl. Other biochemical, hematological test results and urine examination were all normal. Chest X ray, abdominal USG revealed no pathology. She had blood cultures which yielded no pathological growth of any bacteria and several serological tests for Toxoplasmosis, EBV, CMV, HBV, HCV, HAV, HIV, and Rubella which indicated past infections. She had a mild IgG2 positivity, together with ASMA: 1/80 (+) and LC-1 antibodies positivity in high titers. Liver biopsy revealed chronic hepatitis(interface hepatitis). Results: She was diagnosed as AIH and immunosuppressive therapy with methylprednisolon 50 mg/day and azothiopurin 50 mg/day were started. Fever was under control after 48 hours of medication and 5 days later her CRP and other laboratory parameters returned to normal values. She is still under maintanance therapy. Conclusion: Acute onset of AIH is a rare clinical manifestation of the chronic disease, and high fever being the initial and sole symptom is also rarely reported. Furthermore, Type 1 OIH is usually together with ANA and ASMA positivity, where as in type 2 OIH anti LKM 1 and anti LC-1 positivity are characteristic findings. Our case is considered as a rare case because of high fever being the initial symptom and both ASMA and anti LC-1 positivity were demonstrated. We highly recommend to look for AIH when investigating the etiology of high fever when there is no specific clinical data to indicate any infectious disease.