Syncytial giant-cell hepatitis due to autoimmune hepatitis type II (LKM1+)presenting as subfulminant hepatitis

Giant cell hepatitis (GCH) in adults is a rare event. The diagnosis of GCH is based on findings of syncytial giant hepatocytes. It is commonly associa ted with either viral infection or autoimmune hepatitis type I. A patient w ith GCH due to autoimmune hepatitis type II (LKM1+) is described, a combina tion that has not been previously reported. Corticosteroid therapy was effe ctive in decreasing serum Liver enzymes; however, the patient deteriorated rapidly and developed subfulminant hepatic failure. Although an emergency o rthotopic liver transplantation was performed, the patient died because of reperfusion injury. Interestingly, only a few giant hepatocytes were noted in the explanted liver. This case stresses the association of GCH with auto immune disorders, the possible immune mechanism involved in the formation o f giant cell hepatocytes, and illustrates the rapidly progressive course an d unfavorable prognosis that these patients can develop. (Am J Gastroentero l 2000;95:799-801. (C) 2000 by Am. Coll. of Gastroenterology).