ISSN 2148-4902
e-ISSN 2536-4553
 

Volume : 6 Issue : 2 Year : 2019

 
A Case Of Autoımmune Hepatitis Following Pegylated Interferon Treatment Of Chronic Hepatitis Delta [North Clin Istanb]
North Clin Istanb. Ahead of Print: NCI-47701 | DOI: 10.14744/nci.2019.47701  

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

Feruze Enc, Celal Ulasoglu
Department of Gastroenterology, Istanbul Medeniyet University, Goztepe Education and Research Hospital

Autoimmune hepatitis may be frequently associated with chronic hepatitis C (HCV) infection, but there are less case reports regarding hepatitis B and Delta infection (HBV+HDV) as possible triggers. We present a 44 years old man who was diagnosed as autoimmune hepatitis (AIH) following treatment of HBV+HDV hepatitis with pegylated interferon (PegIFN). He presented with complaint of fatigue. Laboratory indicated elevated liver enzymes, AST 64 IU/L and ALT 112 IU/L. The results revealed HBsAg and anti-delta antibody positivity. HBV-DNA was <31.6 IU/mL and HDV-RNA 487.300 copy/mL. Peg-IFN was initiated for 96 weeks. Without serious adverse effect, the enzymes regressed to normal within 24 weeks. After 96 weeks treatment, there was a three-fold increase in aminotransferases, with no cholestasis. Immunoglobulin-G (IgG) was 3686 mg/dL (reference 540-1822 mg/dL), anti smooth muscle antibody (ASMA) and anti-nuclear antibody (ANA) were positive. Liver biopsy had all diagnostic clues for AIH. Methylprednisolone and azathioprine treatment was initiated with tenofovir (TdF) prophylaxis. Due to unresponsiveness even with doubling the dosage for immunosuppresives, treatment was stopped and shifted to mycophenolate mofetil. The patient responded in 6th month and still under treatment with TdF and mycophenolate mofetil with normal enzymes and negative HDV RNA.

Keywords: autoimmune hepatitis, interferon, chronic hepatitis delta


Pegile İnterferonla Kronik Hepatit Delta Tedavisini Takiben Gelişen Otoimmün Hepatit Olgusu

Feruze Enc, Celal Ulasoglu
Department of Gastroenterology, Istanbul Medeniyet University, Goztepe Education and Research Hospital

Otoimmün hepatit, sıklıkla kronik hepatit C (HCV) enfeksiyonu ile ilişkili olabilir, ancak olası tetikleyiciler olarak hepatit B ve Delta enfeksiyonu (HBV + HDV) ile ilgili daha az vaka bildirimleri vardır. Bu raporda HBV + HDV hepatitin pegile interferon (PegIFN) ile tedavisini takiben otoimmün hepatit (AIH) tanısı alan 44 yaşında bir erkek hasta sunulmaktadır. Tetkiklerinde AST 64 IU / L ve ALT 112 IU / L bulundu, ileri incelemede HBsAg ve anti-delta antikoru pozitif bulundu. HBV-DNA <31.6 IU/mL ve HDV-RNA 487.300 kopya/mL idi. Peg-IFN, 96 hafta boyunca başlatıldı. Ciddi yan etki olmadan, enzimler 24 hafta içinde normalleşti. Toplam 96 haftalık tedaviden sonra, aminotransferazlarda kolestaz olmaksızın üç kat artış oldu. İmmünglobülin-G (IgG) 3686 mg/dL (referans 540-1822 mg/dL), anti-düz kas antikoru (ASMA) ve anti-nükleer antikor (ANA) pozitif idi. Karaciğer biyopsisinde AIH için tipik bulgular mevcuttu. Metilprednizolon ve azatiyoprin tedavisi yanısıra tenofovir (TDF) profilaksisi başlandı. İmmünsupresiflerin çift doza çıkılmasına rağmen yanıt alınamadı, tedavi durduruldu. İmmünsupresif olarak 2 kez 1 gram Mikofenolat mofetil'e geçildi. Hasta 6. Ayda tam yanıt verdi, halen enzimler normal ve HDV RNA negatif, Mikofenolat mofetil ve TDF ile tedavi altında izlenmektedir.

Anahtar Kelimeler: otoimmün hepatit, interferon, delta hepatiti




Corresponding Author: Feruze Enc


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