Diagnosis of Chronic Active Hepatitis: A Review of 100 Cases

Abstract

We reviewed 100 consecutive cases of chronic active hepatitis, 50 of cirrhosis and 25 of chronic persistent hepatitis. Hepatitis B surface antigen was positive in 51 of the chronic active hepatitis cases and antinuclear factor, smooth muscle antibody, and antimitochondrial antibody were negative in all except one test. In contrast to the findings in chronic autoimmune hepatitis, 69% of our patients were male; symptoms were usually nonspecific; fever, arthritis, and autoimmune manifestations were absent; and anemia occurred in only six cases. The diagnosis of chronic hepatitis was often first suggested by routine biochemical profiles. Serum albumin, bilirubin, alkaline phosphatase, and lactic dehydrogenase were abnormal in less than 50%. Serum alanine aminotransferase (SGPT) was abnormal in 93% at time of biopsy and exceeded the aspartate aminotransferase (SGOT) in all cases of chronic persistent hepatitis, 95% of mild and moderate chronic active hepatitis, 77% of severe chronic active hepatitis, and 21% of cirrhosis. If the alanine aminotransferase/aspartate aminotransferase (SGPT/SGOT) ratio is less than 1, cirrhosis, hepatoma, or alcoholic liver disease should be suspected. The serum transaminase levels did not correlate with histological severity of chronic active hepatitis, showed marked fluctuation, and became normal in 39% of untreated patients during a mean follow-up period of 11 months. The serum transaminase levels therefore should not be used to monitor disease progression.

Pathology of Brucellosis: A Review of 88 Biopsies

“…Therefore, presumably chronic active hepatitis in these patients was unrelated to brucellosis and was perhaps a reflection of the high incidence of chronic active hepatitis in our patient population. 20 Involvement of the heart in brucellosis is uncommon but is an important cause of death in fatal brucella infections. The hallmark of brucella lesions in the heart is endocarditis.…”