2 CASES OF RECURRENT HEPATIC-INJURY ASSOCIATED WITH EARLY-PREGNANCY -HCG ON HEPATOCYTES IS A SUSPECTED TARGET ANTIGEN FOR LYMPHOCYTE ATTACK

Two cases of recurrent hepatic injury which appeared in the first trim ester of pregnancy were studied. Case 1 was a 35 year old woman, gravi da 4, para 0, who suffered repeatedly from hepatic injury requiring in duced abortions. The patient was healthy before the pregnancies and th e plasma aminotransferases increased after 8 weeks gestation and promp tly returned to normal after the abortions. No fluctuation of aminotra nsferases was observed in the menstrual cycle. A liver biopsy immediat ely after abortion showed spotty necrosis of hepatocytes with mononucl ear cell infiltration. Most of the infiltrating cells were cytotoxic T cells that were directly in contact with hepatocytes. Numerous lympho cytic infiltrations were also found in the decidua of the uterine cure ttage material. The patient's lymphocytes showed conspicuous blast tra nsformation in culture with human chorionic gonadotropin (hCG). The hC G was detected in close vicinity to the injured hepatocytes by immunos taining. Case 2 was a 23 year old woman, gravida 2, para 0, who underw ent an induced abortion due to hepatic dysfunction in the first pregna ncy. Although hepatic dysfunction reappeared from 10 weeks gestation d uring the second pregnancy, her health gradually improved with conserv ative therapy and resulted in a full-term delivery. She lacked allergi es to drugs or foods and was healthy when she was not pregnant. These two cases suggest that some hepatotoxic materials appeared transiently in the first trimester. The results of Case 1 suggest strongly that h CG on the hepatocytes was recognized as an antigen and evoked lymphocy tic attack.