Tabak Fehmi, Ozdemir Filiz, Tabak Omur, Erer Burak, Tahan Veysel, Ozaras Resat
Istanbul University, Cerrahpasa Medical Faculty, Department of Infectious Diseases.
Ann Hepatol. 2008 Apr-Jun;7(2):177-9.
Hepatitis A virus (HAV) is the most common cause of acute viral hepatitis in the world. Rarely, acute infection may persist for a long time. Autoimmune hepatitis (AIH) may provide anti-HAV IgM positivity detection for a prolonged time. On the other hand, HAV as an infectious agent may also trigger AIH. Here we presented a case which seemed like a simple acute viral hepatitis A infection at the beginning but turned out to be an AIH according to the International Autoimmune Hepatitis Group's system. A 21-year-old female was diagnosed as symptomatic acute HAV infection with anti-HAV IgM positivity and elevated aminotransferase levels. The other viral serological tests were negative. On the 6th, 12th and 18th months of the follow up, her anti-HAV IgM positivity still continued and transaminase levels were also 3 to 7 times high of the upper limit of normal. In addition, antinuclear antibody was positive. However, on the 19th month anti-HAV IgM could be detected as negative. Liver histology was prominent. The patient had a score of 16 according to the International Autoimmune Hepatitis Group's system. She was given prednisolone (10 mg/day) and azathioprine (100 mg/day). The aminotransferase levels were detected within normal ranges at the end of the first month of therapy. She was in remission during follow up for 6 years. In conclusion, prolonged HAV infection and AIH may not only trigger each other but also deteriorate the liver histology. AIH should be investigated in cases of long-lasting HAV infection in order to begin the treatment earlier. On the other hand, AIH patients should also be vaccinated for both HBV and HAV to avoid more severe diseases.
甲型肝炎病毒（HAV）是全球急性病毒性肝炎最常见的病因。急性感染很少会长期持续。自身免疫性肝炎（AIH）可能导致抗-HAV IgM阳性检测结果持续较长时间。另一方面，HAV作为一种感染因子也可能引发AIH。在此，我们报告了一例起初看似单纯急性甲型病毒性肝炎感染，但根据国际自身免疫性肝炎小组的诊断系统最终被诊断为AIH的病例。一名21岁女性被诊断为有症状的急性HAV感染，抗-HAV IgM阳性且转氨酶水平升高。其他病毒血清学检测均为阴性。在随访的第6个月、12个月和18个月时，她的抗-HAV IgM仍为阳性，转氨酶水平也比正常上限高3至7倍。此外，抗核抗体呈阳性。然而，在第19个月时抗-HAV IgM检测为阴性。肝脏组织学表现明显。根据国际自身免疫性肝炎小组的诊断系统，该患者得分为16分。给予她泼尼松龙（10毫克/天）和硫唑嘌呤（100毫克/天）。治疗第一个月末检测到转氨酶水平在正常范围内。在随后的6年随访中她病情缓解。总之，长期的HAV感染和AIH不仅可能相互引发，还会使肝脏组织学恶化。对于长期的HAV感染病例应进行AIH的排查以便更早开始治疗。另一方面，AIH患者也应接种乙肝疫苗和甲肝疫苗以避免病情加重。
