SUCCESSFUL REVERSAL OF CHRONIC ACTIVE HEP ATITIS BY GIVING AN AGAMMAGLOBULINEMIC PATIENT INTRAVENOUS IMMUNOGLOBULINS

Background. - Rapid progression of chronic active hepatitis can occur in patients with hypogammaglobulinemia. This report describes the succ essful of IV immunoglobulins to treat chronic hepatitis in a child wit h agammaglobulinemia. Case report. - A 17 month-old boy was admitted b ecause he had suffered from recurrent infections since the age of 6 mo nths. His family history was normal. Clinical and laboratory investiga tions showed hepatomegaly, agammaglobulinemia with the absence of IgG, IgA IgM and IgE, absence of beta cells, normal T cells, normal T cell proliferation and normal levels of complement, elevated ALAT (70 and 200 IU/ml) and ASAT (60 and 188 IU/ml). Liver biopsy showed typical fe atures of chronic active hepatitis. The cause of this hepatitis (B and C virus, EBV, autoimmune markers) was not found. The patient was firs t given gammaglobulins (80 mg/kg) every week, subcutaneously, for 9 we eks, which did not change his transaminasemia. A second course of gamm a-globulins, 400 mg/kg every 3 weeks, intravenously, for 6 months, res ulted in a transient normalization of transaminases for 3 months. Defi nitive normalization was only obtained when the patient was given IV g ammaglobulins (400 mg/kg/week) which gave a residual level of blood Ig G of 10 g/l. This apparent cessation of hepatitis activity was confirm ed by a second liver biopsy. The patient is now given IV gammaglobulin s, twice a month, producing a residual blood IgG concentration of 5 g/ l. Conclusions. - The activity of this chronic hepatitis is closely co rrelated with the residual blood IgG concentration. Gammaglobulins cou ld help neutralize virus extra-cellularly, although the viral origin o f this hepatitis has not been demonstrated.