IDIOPATHIC CHRONIC ACTIVE HEPATITIS - A DIAGNOSTIC AND THERAPEUTIC DILEMMA

A 56-year-old Saudi male was admitted with abnormal liver chemistry va lues and a > 5-month history of lethargy, malaise, anorexia, and jaund ice. Extensive investigations did not establish an etiological diagnos is. Liver histology confirmed the clinically apparent aggressive hepat itis with fibrosis but gave no clue to its etiology. The patient was e mpirically treated with alpha-interferon for presumed non-A, non-B hep atitis, with clinical and biochemical worsening. Interferon was discon tinued and the patient was started on immunosuppression. Dramatic clin ical and biochemical improvement occurred, with normalization of the l iver chemistry within 4 weeks. The patient has been followed-up for 12 months and has not suffered a relapse. This case highlights the etiol ogical heterogenicity of chronic active hepatitis. The entity of autoi mmune chronic active hepatitis is unclear, and perhaps it is better de fined as steroid-responsive hepatitis. Steroid-responsive hepatitis sh ould always be considered in cases of cryptogenic chronic active hepat itis.