Acute Presentation of Autoimmune Hepatitis: Case Report

Jaya Ghosh, J. Ghosh
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Abstract

This case report describes the clinical presentation, diagnostic evaluation, and treatment outcome of a 38-year-old female patient presenting with yellow discoloration of eyes and urine, along with associated symptoms such as nausea, poor appetite, abdominal pain, extreme fatigue, and mild joint pain. The patient had a history of amenorrhea for three months and no family history of autoimmune disease or drug-induced liver injury. Upon examination, the patient exhibited deep icterus and mild tender hepatomegaly, but without signs of acute liver failure. Laboratory investigations revealed elevated liver function markers and positive autoimmune antibodies, including antinuclear antibody (ANA) and anti-smooth muscle antibody (ASMA), while ruling out other possible etiologies such as viral hepatitis, Wilson's disease, and hemochromatosis. Imaging studies showed features of acute hepatitis, and liver biopsy could not be performed due to prolonged prothrombin time. The patient was diagnosed with probable autoimmune hepatitis (AIH) and initiated on a treatment regimen consisting of prednisolone 40 mg daily, which was gradually tapered over time and added azathioprine 100 mg daily. The patient demonstrated significant improvement in liver function tests with this treatment approach. However, she discontinued treatment on her own accord but continued to have normal liver function during subsequent follow-up visits. During the consultation, the patient and healthcare provider engaged in a comprehensive discussion concerning the significance of sustained treatment over an extended period and the inherent possibility of relapse.
自身免疫性肝炎的急性表现:病例报告
本病例报告描述了一名 38 岁女性患者的临床表现、诊断评估和治疗结果,患者出现眼睛和尿液变黄,并伴有恶心、食欲不振、腹痛、极度疲劳和轻微关节痛等症状。患者有三个月的闭经史,无自身免疫性疾病或药物性肝损伤家族史。经检查,患者出现深黄疸和轻度触痛性肝肿大,但没有急性肝衰竭的迹象。实验室检查显示肝功能指标升高,自身免疫抗体阳性,包括抗核抗体(ANA)和抗平滑肌抗体(ASMA),同时排除了其他可能的病因,如病毒性肝炎、威尔逊氏病和血色病。影像学检查显示出急性肝炎的特征,由于凝血酶原时间延长,无法进行肝活检。患者被诊断为可能患有自身免疫性肝炎(AIH),并开始接受每天 40 毫克泼尼松龙的治疗方案,随着时间的推移逐渐减量,并添加了每天 100 毫克硫唑嘌呤。采用这种治疗方法后,患者的肝功能检测有了明显改善。然而,她主动中断了治疗,但在随后的随访中,肝功能仍保持正常。在会诊期间,患者和医疗服务提供者就长期持续治疗的意义以及固有的复发可能性进行了全面讨论。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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