Autoinmne hepatitis associated with hepatitis A virus infection, a case report

Introduction and Objectives

Hepatitis due to Hepatitis A Virus (HAV) is an entity that has been described as a causal factor of HAI, the prevalence and course of which is reported to be 1% - 3%. The diagnosis is associated with AIH is usually made in the acute event; a time criterion is not well defined.

Materials and Patients

41-year-old male, with a history of DM2, systemic arterial hypertension and rheumatoid arthritis, onset in June 2023 with fever and gastrointestinal symptoms (vomiting, nausea and stools with reduced consistency), associated with jaundice of 1 week after his symptoms. Diagnosis of Acute Liver Injury due to HAV is confirmed on 06/22/23, with Ac. IgM VHA (8.7 +), Transaminases >2000U/L and INR 2.4; support therapy and symptom control began with partial resolution on 09/2023. He subsequently re-entered the emergency area 11/2023 with jaundice, abdominal pain, and excessive fatigue. Acute Hepatitis was again determined with transaminases >2000 U/L, a 3F CT scan was performed and was normal, and the approach for autism was complemented with the following panel: negative ANAS and positive ASMAs 1:100, IgG 2780. Liver biopsy confirmed AIH. morphological changes compatible with autoimmune hepatitis. Treatment was started with Prednisone 0.5mg/kg, with subsequent maintenance based on Azathioprine, achieving biochemical remission 04/2024

Results

It has been postulated that HAV infection, as occurs with other viral infections, may be a triggering factor for latent AIH in susceptible individuals, considering multiple pathways of inflammation and immunotolerance defects. Most of the reported cases are diagnosed 5 months after the acute event HAV; in the case of our patient, it was 6 months after the acute event, completing a score of 7 points by the simplified system. In case reports of OAB-associated AIH, treatment has been initially established with oral Prednisone 0.5 to 1 mg/kg day, with maintenance of Azathioprine or Mycophenolate Mofetil with comparable response rates. The goal of treatment is biochemical and histological remission with the goal of avoiding progression of liver damage and mortality.

Conclusions

Viral infections have been associated with the development of autoimmune hepatitis, HAV in up to 3% based on case reports due to the rarity of the presentation. The pathophysiology of presentation triggered by OAB is poorly defined. Biopsy and differential diagnoses are the mainstay in the approach to these patients.