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.