POST-INFANTILE GIANT-CELL HEPATITIS - A S TUDY IN 17 PATIENTS

Objectives. - Giant-cell hepatitis is rare in adults and its significa nce has not been clarified. We report the clinical and histological ch aracteristics and outcome in a group of adult patients with giant-cell hepatitis. Methods. - Seventeen patients with giant-cell hepatitis, h ospitalized in our unit between 1976 and 1992, were studied retrospect ively. Giant-cell hepatitis was defined as at least two hepatocytes wi th four or more nuclei per cell on liver biopsy. Clinical and biochemi cal parameters, liver histology, and the serological profile of HAV, H BV, HCV, HIV, HSV, EBV, CMV, and paramyxovirus were evaluated. Paramyx ovirus immunochemistry was performed in 6 liver biopsies. Results. - T here were 11 females and 6 males, an average of 48 years old (range: 2 9-80). Four patients had a well-defined etiology: acute hepatitis B in fection with a favorable outcome in 2 cases, clometacine induced-hepat itis resulting in death from liver feature in one case, and chronic he patitis B and C in one patient with AIDs. Among the 13 patients in whi ch the etiology could not be determined, histologically defined acute hepatitis was observed in 8 and chronic hepatitis in 5. Nine patients were treated with immunosuppressive drugs. One patient was lost to fol low-up. Eight patients responded to treatment, but 5 patients progress ed to cirrhosis between 5 months and 7 years. Two of the 4 patients wi th unexplained liver disease who did not receive any treatment died of liver failure. Conclusion. - In patients with acute or chronic hepati tis without an identified cause (with or without autoimmune abnormalit ies), the presence of giant-cell hepatitis seems to have a similar evo lution as active autoimmune hepatitis. The poor prognosis of these pat ients suggests that early immuno-suppressive treatment is justified.