Acute Liver Failure by Autoimmune Hepatitis (AIH) and Liver Cirrhosis in Adolescent Patient: Case Report

Case Report

Austin J Gastroenterol. 2016; 3(2): 1062.

Acute Liver Failure by Autoimmune Hepatitis (AIH) and Liver Cirrhosis in Adolescent Patient: Case Report

Zamarripa VL¹, Valdez PRA¹, Ramirez LDH¹, Barrios OC¹ and Ochoa MC²*

¹Department of Family Medicine, Family Medicine Unit #1 (IMSS), Mexico

²Department of Pediatrics, Regional General Hospital #1 (IMSS), Mexico

*Corresponding author: Ochoa Maria Citlaly, Department of Pediatrics, Regional General Hospital #1 (IMSS), Sonora Delegation, Sonora, México, Colonia centro, Cd. Obregon, Sonora, Mexico

Received: July 18, 2016; Accepted: August 17, 2016; Published: August 19, 2016


Autoimmune hepatitis (AIH) is defined as chronic liver parenchyma inflammation of unknown etiology. In pathogenesis are involved environmental triggers and immunological tolerance in genetically predisposed patients resulting in liver parenchymal attack by T lymphocytes. For diagnosis, histologic features and specific analytic are required (hypergammaglobulinemia and specific autoantibody), disease is classified as type 1 (ANA and/or SMA and/ or SLA positive) and type 2 (LKM-1 and/or LC1 positive).In few cases AIH remission is acquired, main goal of treatment is to modify natural history, relieve symptoms, improve biochemical parameters and decrease liver tissue inflammation and fibrosis. We report a 19 years old female with acute liver failure secondary to relapse autoimmune hepatitis and liver cirrhosis with a clinical course of 16 years in maintenance treatment with prednisone who presented multiple complications.

Keywords: Autoimmune hepatitis; Acute liver failure; Adolescence


First autoimmune hepatitis reference was in 1942 known as lupus hepatitis [1]. In Atlanta, Georgia (1999) was named as autoimmune hepatitis (AIH) and criteria for diagnosis were determined [2]. Currently, AIH is considered a progressive necro-inflammatory and chronic liver disease which is characterized by presence of immunological abnormalities (hypergammaglobulinemia and autoantibodies), with a good response to immunosuppressive therapy and higher prevalence in women (3.6:1) [3]. Pathogenesis is result of alterations in immune tolerance, genetic predisposition and environmental factors. There are potential “triggers” as infectious agents (measles virus, hepatitis virus, cytomegalovirus, and Epstein- Barr virus) and drugs (antibiotics, statins, and anti-TNF) [4].

AIH as a world wide incidence of 1-2 cases per 100,000/year, a prevalence of 10-20 cases per 100,000/year and is observed in all ethnic groups. Highest incidence occurs in adolescence and between 35-40 years [5]. AIH diagnosis is based on a scoring system developed by International Autoimmune Hepatitis Group (IAIHG) in 1999 and updated in 2010 [6]. In USA, AIH is leading cause of chronic liver disease in 11-23% cases [7]. Specifically in Latin America and Mexico it is not exactly known AIH prevalence.

Case Presentation

Female 19 years old, native and resident of Cd. Obregon, Sonora, Mexico, with weight and height according to age. Started her condition in October 2000 at age of three with episodic epistaxis and two months later with jaundice, acholia, and choluria. Initial laboratory tests revealed elevation of aminotransferases; liver ultrasonography was normal. With clinical data, diagnosis of acute viral hepatitis was considered. Was treated with unspecified symptomatic management.

Eight months later continued with episodic epistaxis and jaundice; a new liver ultrasound showed multiple regenerative nodules, steatosis and portal hypertension. She was hospitalized and laboratory tests reported (Table 1): cholesterol 100 mg; total protein 7.6 g; albumin 3.2 g; globulin 5.5 g; direct bilirubin 1.8 mg; indirect bilirubin 1.6 mg; alanine aminotransferase (ALT) 880 IU; aspartate aminotransferase (AST) 452 IU; alkaline phosphatase (AF) 678 IU; lactate dehydrogenase (LDH) 302 IU; gamma glutamyl transferase (GGT) 425 IU; prothrombin time (PT) 22 sec, partial thromboplastin time (PTT) 31 sec. Serology panel for hepatitis B, C and HIV was negative. Due to persistence of symptoms for more than 6 months a liver biopsy was performed. Histopathological result: presence of necrosis bridges to portal space with regenerative nodules, inflammatory infiltrate composed by lymphocytes and plasma cells in liver parenchyma. Right lobule with multifocal hepatocellular necrosis and some rosettes. Histological diagnosis was chronic hepatitis probably autoimmune and moderate fibrosis.

Citation: Zamarripa VL, Valdez PRA, Ramirez LDH, Barrios OC and Ochoa MC. Acute Liver Failure by Autoimmune Hepatitis (AIH) and Liver Cirrhosis in Adolescent Patient: Case Report. Austin J Gastroenterol. 2016; 3(2): 1062. ISSN : 2381-9219