POST-INFANTILE GIANT-CELL HEPATITIS IN AN ELDERLY FEMALE-PATIENT WITHSYSTEMIC LUPUS-ERYTHEMATOSUS

A 69-year-old Japanese female was admitted because of general fatigue. Laboratory data showed elevation of serum total bilirubin, transamina se, gamma-glutamyl transpeptidase, and creatinine levels. An immunolog ical study revealed hypergammaglobulinemia, low titer of complement, a nd high titers of antinuclear antibody, anti-DNA antibody, and circula ting immune complexes. Antibodies to parainfluenza virus 3 were positi ve. Histology of the liver disclosed numerous giant cell hepatocyte tr ansformations with the lobular architecture being slightly distorted b y portal inflammation and fibrosis. These findings led us to make a di agnosis of giant cell hepatitis associated with systemic lupus erythem atosus. Prednisolone was effective in improving the anemia and the ser um immunoglobulin, immune complex, and antinuclear antibody levels. Th e addition of cyclosporine to the initial corticosteroid therapy was a lso beneficial in decreasing the transaminase level and in improving l iver histology. The patient died of acute pneumonitis and renal failur e on the 166th day after admission. Parainfluenza virus 3 and autoimmu ne mechanisms were thus considered to be the causes of the giant cell hepatitis.