PROLONGED INTRAHEPATIC CHOLESTASIS IN ACUTE-ONSET, SEVERE AUTOIMMUNE HEPATITIS

A 72-year-old woman was admitted because of jaundice and hepatocellula r dysfunction. She was diagnosed with autoimmune hepatitis from labora tory test results showing high titers of antinuclear antibodies and ne gativity for hepatitis viral markers, Steroid i.v. pulse therapy and o ral administration of prednisolone were effective in improving the liv er function test results, except for hyperbilirubinemia, Elevated seru m bilirubin levels? of approximately 20 mg/dl persisted for more than 6 months, despite the administration of ursodeoxycholic acid, Insulin- glucagon therapy was given for normalization of transaminases and then withdrawn 3 weeks after admission, but it was resumed at 3 months, re sulting in a dramatic decrease in serum bilirubin levels, which then n ormalized in 2.5 months, Liver biopsy 6 months after onset showed chro nic active hepatitis with bile plugs. Insulin-glucagon therapy, becaus e of its choleretic effect, may be worth continuing even after recover !: of acute hepatic failure.