A Case of Acute Autoimmune Hepatitis Superimposed on Chronic Hepatitis B Infection

Abstract

Autoimmune hepatitis has been associated with chronic HCV infection, but there are only few cases reported of HBV infection as a possible trigger. We present a case of a young male who was diagnosed with acute autoimmune hepatitis superimposed on existent chronic HBV infection. A 30-year-old Hispanic male with no past medical history presented to the hospital with complaints of few days of generalized weakness. Laboratory findings were significant for elevated liver enzymes: AST, 1164 U/L; ALT, 1461 U/L; total bilirubin, 2 MG/DL; and alkaline phosphatase, 75 IU/L. Extensive workup was done to find the etiology for elevated liver enzymes. Only blood work that came back positive was for chronic HBV infection and elevated immunoglobulin G (IgG) level 1937 mg/dL. HBV viral load was 42,900,000 IU/mL. The patient was started on tenofovir 300 mg daily. Liver biopsy was done which was consistent with autoimmune hepatitis. Prednisone 60 mg daily was started. Six months later, blood work showed completely normal liver enzymes and total IgG. Hepatotropic viruses have been proposed as triggering factors for several autoimmune diseases. There are theories suggesting that similarity in viral epitope and self-proteins expression on liver cells' surface causes a cross-reactive immunologic response and possible viral-induced autoimmune hepatitis.

Graves’ disease overlapping with chronic hepatitis B and methimazole-induced liver injury and autoimmune hepatitis: a case report

“…AIH was then identified based on features of typical histology and immunology and good response to steroid, speculating MMI as a possible trigger for AIH. However, we can’t exclude the possibility of HBV as a trigger for AIH [ 12 , 13 ].…”

“…AIH superimposed on CHB has also been reported. However, there are different opinions as to whether hepatitis B virus (HBV) functions as a trigger for AIH [ 12 , 13 ].…”

Superposición de hepatitis B a hepatitis autoinmune. Diagnóstico y tratamiento, presentación de un caso clínico y revisión de casos clínicos en la literatura internacional

“…Los virus pertenecientes al grupo de los virus hepatotrópicos se han propuesto como factores desencadenantes de varias enfermedades autoinmunes, sin embargo, antes de establecer un diagnóstico certero se requiere de excluir a otras enfermedades crónicas hepáticas. (Sostre, Patel, Mohamed, & Volfson, 2018). Los autoanticuerpos no específicos de órganos (NOSA), concretamente los anticuerpos antinucleares (ANA) y los anticuerpos contra el músculo liso (SMA), han sido notificados repetidamente en pacientes contagiados por el VHB y el VHC.…”

A Case Of Autoımmune Hepatitis Following Pegylated Interferon Treatment Of Chronic Hepatitis Delta

“…Autoimmune hepatitis (AIH) is an uncommon, chronic liver inflammation with an unclear etiology [ 1 ]. AIH is characterized by fluctuating alanine aminotransferase (ALT) levels in serum, marked hypergammaglobulinemia and circulating organ and non-organ specific autoantibodies [ 2 , 3 ]. Like most of the autoimmune diseases, AIH is predominant in females with a prevalence of less than 0.02% [ 1 , 2 ].…”

“…AIH is characterized by fluctuating alanine aminotransferase (ALT) levels in serum, marked hypergammaglobulinemia and circulating organ and non-organ specific autoantibodies [ 2 , 3 ]. Like most of the autoimmune diseases, AIH is predominant in females with a prevalence of less than 0.02% [ 1 , 2 ]. In genetically predisposed individuals, exposure to environmental factors triggers the autoimmune cascade.…”