Long-term observation of acute-onset autoimmune hepatitis presenting clinically and radiologically as acute hepatitis
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There is yet no gold standard for the diagnosis of acute-onset autoimmune hepatitis (A-AIH), especially histologically acute AIH. As a result, long-term observation of A-AIH has been difficult and the nature is not well known. We retrospectively analyzed the clinicopathological features of A-AIH over a long prospective follow-up period.
Clinical, biochemical, immunological and pathological features of 30 patients (21 female, mean age 55.1 ± 13.1 years) with non-severe A-AIH “without signs of clinical and radiological chronicity” admitted to a community hospital between 2001 and 2015 who were prospectively followed for more than 2 years were analyzed retrospectively.
Liver histology of 45% showed acute and 55% chronic hepatitis. Mean age was older, prothrombin time activity was higher, AIH scores before treatment were lower in histologically acute hepatitis than histologically chronic hepatitis significantly. Liver fibrosis was not coarse, but delicate with severe activity in most patients showing chronic hepatitis defined by our strict criteria. Median (range) follow-up period was 6.9 (2.1–16.2) years. Six (20%) patients experienced episode of relapses. All were alive at the last follow-up point. Corticosteroid was continued at 2.5–5 mg/day until the study end point without serious side effects in most patients. Serial change of alanine aminotransferase levels, immunoglobulin G levels and anti-nuclear antibody titers did not show statistical difference between histologically acute and chronic hepatitis.
Rapid progression of fibrosis could occur in A-AIH. Treatment response and long-term prognosis were good, and not different between patients with histologically acute and chronic hepatitis.
KeywordsAutoimmune hepatitis Acute presentation Non-severe Long-term observation Histology
Acute-onset autoimmune hepatitis
We are indebted to all our colleagues at our liver units who cared for the patients described herein. We thank Nobuyuki Moriya (Chiba Medical Center) for help in the extraction of old data.
KF designed and performed the research, analyzed the clinical data and wrote the manuscript. KF, YF, KS, MS, SY, OY and NK contributed to the clinical aspects. KF and MN reviewed the histopathological changes. All authors approved the final version of the manuscript.
Compliance with ethical standards
Conflict of interest
Keiichi Fujiwara, Yoshihiro Fukuda, Katsushi Seza, Masaya Saito, Shin Yasui, Masayuki Nakano, Osamu Yokosuka and Naoya Kato declare that they have no conflict of interest.
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008.
Informed consent was obtained from all patients for being included in the study.