JAUNDICE AND PROGRESSIVE LIVER-FAILURE - DELAY IN DIAGNOSIS OF AUTOIMMUNE HEPATITIS AFTER RAPID TERMINATION OF STEROID-THERAPY

A 27-year-old woman was successfully treated with a highly dosed stero id therapy over several months during summer 1994 in the event of urti caria. In October 1994. when the patient was complaint free, therapy w as abruptly terminated. In November 1994 jaundice, nausea and loss of appetite occurred. Biochemical results showed markedly elevated serum transaminases: negative hepatitis serology, normal immunoglobulins and inconspicious autoantibodies. Histology showed a florid hepatitis. In January 1995 the patient was hospitalized again in very low general a nd nutritional condition with a marked jaundice, high serum transamina ses, insufficient liver synthesis function, established ANA (+), ASMA (++) and normal immunoglobulins. This time histology painted out an ac tive hepatitis going into liver cirrhosis. Evaluation in view of liver transplantation was carried out in this case of liver failure. At tha t time, tests showed a distinct gamma globulin fraction increase altho ugh the antibody pattern had remainded identical. An immunosuppressive therapy with azathioprine and steroids was decided upon under suspici on of an autoimmune hepatitis leading to a prompt positive response an d therefore confirmation of the diagnosis. Complete biochemical remiss ion was attained in April 1995 and a complete histological remission i n March 1998.