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• W2977733238 abstract "Purpose: A 26-year-old Caucasian male with no significant history presented with new onset jaundice for 3 weeks. Two weeks prior to admission, he developed daily nausea and vomiting. One week prior to admission, he developed night sweats, anorexia, constipation, and generalized pruritis. In addition, he began to experience a post-prandial right upper quadrant abdominal pain with no radiation, and a 16-pound weight loss, which prompted presentation to the hospital. His medications included occasional acetaminophen/ diphenydramine PRN for insomnia. Family history was significant for cholelithiasis in his mother and lung cancer in multiple family members. The patient's social history included consumption of approximately 5 oz of spirits per week, a remote tobacco history, experimentation with intravenous heroin, as well as multiple professionally-obtained tattoos. Pertinent physical exam findings included stable vital signs, icterus, a soft and non-tender abdomen with liver edge palpated two cm below the costal margin, and percussed splenomegaly. No lymphadenopathy or asterixis were appreciated. Laboratory findings were significant for AST of 825 U/L, ALT of 596 U/L, total bilirubin of 26 mg/dL with a direct bilirubin of 20 mg/DL, and alkaline phosphatase of 118 U/L. His INR was 1.46 with a PT of 17.4, albumin of 3.1 g/dl, and total protein of 6.8 g/dl. Abdominal ultrasound revealed a nodular liver surface, hepatosplenomegaly, marked gallbladder thickening, and enlarged peripancreatic lymph nodes consistent with acute hepatitis. Hepatitis A, B, and C serologies were negative. His ferritin was 423 ng/mL with a percent saturation of 38. Anti-mitochondrial antibody, anti-LKM and alpha 1 anti-trypsin titers were within normal limits. His total IgG was 2,657 (reference range 650-1,600.) Anti smooth muscle antibody titers were measured at 36 U (reference range <20.) Given his clinical picture, along with an international autoimmune hepatitis group scoring of 10, treatment was started for autoimmune hepatitis with corticosteroids. His clinical picture improved soon thereafter. Discussion: This case represents an unusual presentation of autoimmune hepatitis. Autoimmune hepatitis is typically diagnosed in the fourth or fifth decade of life, and more commonly affects females. It typically presents with markedly elevated ASTs, compared to bilirubin and alkaline phosphatase, as was seen in this case. This presentation demonstrates, however, that this condition can present at any age, and can also affect males. Autoimmune hepatitis should, therefore, remain high on the differential in young males with hepatitis." @default.
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• W2977733238 date "2013-10-01" @default.
• W2977733238 modified "2023-09-23" @default.
• W2977733238 title "An Unusual Presentation of Auto-immune Hepatitis" @default.
• W2977733238 doi "https://doi.org/10.14309/00000434-201310001-01185" @default.
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