RSS Feeds
Chronic Hepatitis with Combined Features of Autoimmune Chronic Hepatitis and Chronic Hepatitis C: Favorable Response to Prednisone and Azathioprine
- Somashekhar Bellary, MD;
- Thomas Schiano, MD;
- Grace Hartman, MD; and
- Martin Black, MD
- From Temple University Hospital, Philadelphia, Pennsylvania. Requests for Reprints: Martin Black, MD, Liver Unit, Department of Gastroenterology, 8th Floor, Parkinson Pavilion, Temple University Hospital, 3401 North Broad Street, Philadelphia, PA 19140. Acknowledgment: The authors thank Lynne Rivers for secretarial assistance. Grant Support: By a grant from Shering-Plough Corporation.
The evidence for an association between autoimmune forms of chronic hepatitis and hepatitis C virus (HCV) infection is controversial [1-3]. Although anti-liver-kidney microsomal antibody-positive autoimmune chronic hepatitis appears to be associated with HCV infection [4], evidence of such an association is less convincing with other subtypes of autoimmune chronic hepatitis [5]. Autoantibodies are frequently found in patients with chronic hepatitis C, although usually in low titers [6-8], which suggests that HCV elicits an immune response in the host. In a small subset of patients with chronic hepatitis C, autoantibodies are seen in high titers along with hypergammaglobulinemia, which further clouds the distinction between autoimmune chronic hepatitis and chronic hepatitis C. This has important therapeutic implications because inappropriate treatment of autoimmune chronic hepatitis with interferon-α may exacerbate liver disease [9, 10]. Conversely, corticosteroid therapy for chronic hepatitis C may enhance HCV replication [11, 12], which could worsen underlying liver disease. Few data are available to show how patients with features of both autoimmune hepatitis and chronic hepatitis C should be treated.
We describe two patients with combined features of autoimmune chronic hepatitis and chronic hepatitis C who showed clinical, biochemical, and histologic responses to treatment with prednisone and azathioprine.
Case Reports
Patient 1
A 74-year-old white woman had an 18-month history of right-sided abdominal pain, progressive fatigue, and persistently elevated serum alanine aminotransferase levels ranging from 1.18 to 1.55 µkat/L. Other medical problems included insulin-dependent diabetes mellitus, hypertension, and hypothyroid disease. She reported no history of blood transfusion, intravenous drug abuse, tattoos, or excessive alcohol use. Her daily medications included 25 mg of hydrochlorothiazide, 16 units of humulin U-100 insulin, 10 mg of enalapril, 0.01 mg of synthroid, and 1 g of acetaminophen. She had no family history of liver disease. Physical examination showed no cutaneous stigmata of chronic …
