Complete Remission of Acute-onset Autoimmune Hepatitis Following Transcatheter Splenic Arterial Embolization and Splenectomy for Spontaneous Splenic Rupture.

Ikue Sekai, Masahiro Takita, Shigenobu Yasuhara, Naoya Omaru, Takuya Matsubara, Masahiro Morita, Hirokazu Chishina, Kosuke Minaga, Satoru Hagiwara, Hiroshi Ida, Misa Kojima, Osamu Maenishi, Tomohiro Watanabe, Masatoshi Kudo
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Abstract

A 62-year-old woman presented with jaundice and fatigue. A blood examination revealed markedly elevated serum transaminase and bilirubin levels and negative hepatitis virus markers. A radiographic examination revealed no bile duct abnormalities. Serum transaminase levels decreased and normalized without immunosuppression after transcatheter arterial embolization and splenectomy for spontaneous splenic rupture, respectively. The pathological findings of the liver biopsy specimens were consistent with those of acute-onset autoimmune hepatitis (AIH), despite normal serum IgG levels. The clinical course of the present case suggests that pathogenic immune responses associated with acute-onset AIH may arise in the spleen, but not in the liver.

自发性脾破裂经导管脾动脉栓塞和脾切除术后急性自身免疫性肝炎完全缓解。
62岁女性,表现为黄疸和疲劳。血液检查显示血清转氨酶和胆红素水平明显升高,肝炎病毒标志物阴性。x线检查未见胆管异常。经导管动脉栓塞和自发性脾破裂脾切除术后,血清转氨酶水平分别下降和恢复正常,无免疫抑制。肝活检标本的病理结果与急性自身免疫性肝炎(AIH)一致,尽管血清IgG水平正常。本病例的临床病程表明,与急性AIH相关的致病性免疫反应可能出现在脾脏,而不是肝脏。
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