Liver dysfunction due to apoptosis in a patient with systemic lupus erythematosus

We report on a 23-year-old Japanese female with a 13-year history of system ic lupus crythematosus (SLE), and two episodes of deterioration followed by treatment with high dose prednisolone. Although she had been recently trea ted with prednisolone (12.5 mg daily), her liver function became worse in J uly 1998. Results of a liver biopsy revealed multi-focal hepatic cell death in a severe fatty liver, without any inflammatory cell invasion. The biops y also showed a positive TUNEL (Tdt-catalysed DNA nick end labelling) react ion indicating apoptosis. Her liver function recovered rapidly following st eroid pulse therapy. Serum soluble Fas ligand (sFasL) was found to be eleva ted to a concentration of 0.395 ng/ml at the time of liver damage, but was less than 0.03 ng/ml before liver damage and after prednisolone treatment. The liver damage in this case appeared to be involved with apoptosis induce d by sFasL. Although hepatitis associated with SLE is rare, apoptosis direc tly related to elevated sFasL levels might cause this complication.