P21 | A case of acute hepatitis: does therapy lead to a diagnosis?

F. Borza¹, M. Delle Monache², M. Fabietti², V. Mura², M. Pellegrinotti², A. Luzi², A. Cappelli² | ¹Dipartimento di Medicina Traslazionale e di Precisione, Università La Sapienza, Roma, ²UOC Medicina Acuti, Ospedale Sant’Eugenio ASL RM 2, Roma, Italy

Premises: Autoimmune hepatitis is a rare and heterogeneous disease in terms of clinical presentation. The diagnosis can be made in the advanced chronic or acute phase. Immunosuppressive therapy can induce complete remission, but it also serves as an important ex adiuvantibus criterion in diagnosis.
Clinical Case Description: A 49-year-old patient underwent blood tests, which incidentally revealed elevated transaminases (AST 85 U/L, ALT 111 U/L). A negative diagnostic process for viral hepatitis began, with negative abdominal ultrasound and CT scan results. Following a further increase in liver cytolysis indices and the onset of jaundice, he was admitted to the emergency room. During hospitalization: AST 1578, ALT 1317, total bilirubin 18.3, GGT 180, ALP 270, hypergammaglobulinemia. Testing for major (HAV, HEV, HBV, HCV) and minor (EBV, CMV, HSV 1 and 2) hepatitis viruses was negative. The abdominal MRI documented hepatomegaly and signs of acute inflammation. Autoimmunity: ANA positive 1:160 homogeneous pattern, AMA/ASMA/ENA negative, liver immunoblot negative. He performed a liver biopsy and started prednisone 50 mg/day while awaiting the results. After 4 days of therapy, a marked reduction in liver cytolysis indices was observed: AST 757, ALT 919, total bilirubin 5.42, ALP 190, GGT 201.
Conclusions: Autoimmune hepatitis should always be suspected in patients with hepatitis of unknown etiology. The presence of autoantibodies, hypergammaglobulinemia, and histology are the basis for diagnosis, but in cases of acute onset and a high probability of the disease, it is crucial not to delay the start of therapy.