EXACERBATED AUTOIMMUNE HEPATITIS SUCCESSFULLY TREATED WITH LEUKOCYTAPHERESIS AND BILIRUBIN ADSORPTION THERAPY

A 58-year-old man with subacute fulminant onset of autoimmune hepatiti s (AIH) was treated by leukocytapheresis (LCAP) and bilirubin adsorpti on therapy (BAT), rather than by administration of high-dose corticost eroids as he had mild glucose intolerance, and a definitive diagnosis of AIH was not obtained on admission; further, there was a risk of vir al infection. After initiation of the therapies, serum transaminases a nd bilirubin, immunoglobulins, anti-nuclear antibodies, and rheumatoid factor decreased rapidly, as did the initially high levels of activat ed cells and several pro-inflammatory cytokines. Liver inflammation ob served on liver biopsy settled during the course of the therapies, wit h no adverse side effects. A pause in the therapies was associated wit h deterioration; however, restoration of apheresis was followed by nor malization. Remission was sustained throughout the period monitored, e xcept for a recurrence 14 months after discharge, which was successful ly resolved by two additional LCAP sessions. These results suggest tha t LCAP influences the causal mechanism(s) of exacerbation of AIH.