Fulminant hepatic failure as the initial presentation of acute autoimmune hepatitis

William Kessler, Oscar Cummings, George Eckert, Naga Chalasani, Lawrence Lumeng, Paul Y. Kwo

Research output: Contribution to journalArticle

158 Citations (Scopus)

Abstract

Background & Aims: Autoimmune hepatitis is a common cause of chronic hepatitis, and acute presentation is thought to be uncommon. The aim of this study was to compare clinical, biochemical, and histological features in patients with autoimmune hepatitis presenting with either acute or chronic hepatitis. Methods: Retrospective review of all patients with autoimmune hepatitis presenting to a University medical center from 1993 to 2002. Results: One hundred fifteen patients with autoimmune hepatitis were identified. Ten patients with autoimmune hepatitis were identified as having acute presentation (group I), and 20 patients with a classic presentation as chronic hepatitis (group II) served as age- and sex-matched controls. All patients met criteria published by the International Autoimmune Hepatitis Group. Patients with acute presentation differed significantly with regard to encephalopathy, albumin levels, and bilirubin levels. Blinded liver biopsy review demonstrated that those with acute presentation had significantly less fibrosis, and significantly greater interface hepatitis, lobular disarray, lobular hepatitis, hepatocyte necrosis, zone III necrosis, and submassive necrosis. Conclusions: In our study, patients with an acute presentation of autoimmune hepatitis differed from patients with a classical presentation clinically, biochemically, and histologically. In our review, a majority of patients with acute autoimmune hepatitis presented with fulminant hepatic failure. The pattern of zone 3 necrosis may be a specific finding in those with acute autoimmune hepatitis.

Original languageEnglish
Pages (from-to)625-631
Number of pages7
JournalClinical Gastroenterology and Hepatology
Volume2
Issue number7
DOIs
StatePublished - Jul 2004

Fingerprint

Autoimmune Hepatitis
Acute Liver Failure
Necrosis
Chronic Hepatitis
Hepatitis
Brain Diseases
Bilirubin
Hepatocytes
Albumins
Fibrosis
Biopsy

Keywords

  • AIH
  • ANA
  • antinuclear antibody
  • autoimmune hepatitis
  • liver-kidney microsomal antibody
  • LKM
  • OLT
  • orthotopic liver transplantation
  • SMA
  • smooth muscle antibody

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Fulminant hepatic failure as the initial presentation of acute autoimmune hepatitis. / Kessler, William; Cummings, Oscar; Eckert, George; Chalasani, Naga; Lumeng, Lawrence; Kwo, Paul Y.

In: Clinical Gastroenterology and Hepatology, Vol. 2, No. 7, 07.2004, p. 625-631.

Research output: Contribution to journalArticle

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