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- W3094628995 abstract "INTRODUCTION: Autoimmune hepatitis (AIH) has been reported to occur after acute hepatitis A infection (HAV). Diagnosis of AIH in this setting is a management dilemma. In 2017, there was an outbreak of HAV infection in Indiana and we report our experiences with four cases of AIH diagnosed after HAV. CASE DESCRIPTION/METHODS: Table 1 describes the characteristics of the four patients. All were Caucasian, mean age was 51 (±16) years. Three were females and one was a male with cirrhosis of unknown etiology. Risk factors for HAV exposure: person to person through the fecal-oral route or intravenous drug use. Symptomatology included fatigue, jaundice, nausea, vomiting and pruritus. HAV was diagnosed by positive hepatitis A IgM serology. Mean time from diagnosis of HAV infection to workup for AIH was 37 (± 19) days. Figure 1 depicts the trend of liver function tests. Patient 1 presented with jaundice and liver tests forty days after an initial improvement in symptoms from HAV. Liver biopsy showed subacute hepatitis, patchy zonal necrosis and plasma cells suggestive of AIH. Patient 2 was a male with cirrhosis of unclear etiology who was transferred for management of acute on chronic liver failure due to HAV. A liver biopsy revealed cirrhotic architecture and interface hepatitis consistent with AIH. Patient 3 is a female with symptomatic HAV. Positive autoantibodies triggered a liver biopsy which was suggestive of AIH. Persistent AIH in follow up liver biopsy prompted initiation of steroids. Patient 4 was a female with persistent elevations in liver tests two months after acute HAV. Pathology showed acute and chronic hepatitis features with plasma cells and was suggestive of AIH. Smooth muscle antibody (SMA) were positive at 1:80 titers in three patients. Immunosuppressive therapy was initiated in patients 1, 3, and 4 with subsequent normalization of liver tests within a mean of 83 (±56) days. Patient 2 did not receive immunosuppressive therapy due to concomitant sepsis with ACLF and died. In patient 4, immunosuppressive therapy was able to be discontinued after 13 months. DISCUSSION: Interesting observations include: (1) About 2-month lag between acute HAV and diagnosis of AIH, (2) seroconversion with exclusive SMA positivity, (3) Normalization of liver enzymes in approximately 3-months, and (4) discontinuation of immunosuppression. In short, in acute HAV infection lack of normalization of liver tests and conversion to SMA positivity should prompt concern for AIH.Table 1Figure 1.: Schematic representation of clinical events with trends of serum liver biochemistries during the clinical course and follow up in patients 1, 2, 3 and 4." @default.
- W3094628995 created "2020-10-29" @default.
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- W3094628995 date "2020-10-01" @default.
- W3094628995 modified "2023-09-26" @default.
- W3094628995 title "S2554 An Outbreak Presents an Opportunity to Learn About a Rare Phenotype: Autoimmune Hepatitis After Acute Hepatitis A" @default.
- W3094628995 doi "https://doi.org/10.14309/01.ajg.0000712264.59284.b3" @default.
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