CYCLOSPORINE TREATMENT OF AN ACUTE HEPATI C-FAILURE REVEALING AN AUTOIMMUNE HEPATITIS

Background. - Autoimmune hepatitis (AIH), usually chronic hepatitis, c an be revealed by an acute episode of hepatic failure not easily treat able. Case report. - A 4 year-old boy presented with severe acute hepa tic failure (AHF) without hypergammaglobulinemia, revealing AIH. A tri ple immunosuppressive treatment (prednisolone, azathioprine, ciclospor ine) was started when clinical and biological signs worsened (prothrom bin time 18%, factor V 32%). Liver functions significantly improved wi thin 10 days, although complications due to intensive immunosuppressio n occurred (Candida septicemia). Conclusion. - AIH must be evocated in each case of AHF. Some observations of AIH treated with ciclosporine are published but protocols of its administration are variable: ciclos porine is used alone or associated with other drugs, in first intentio n or secondarily, when the classical treatment is contra-indicated of fails. Controlled studies are needed to precise ciclosporine indicatio ns in AIH and to propose the best protocol.