Lohani Saroj, Nazir Salik, Tachamo Niranjan, Pagolu Pavani
Internal Medicine Residency, Reading Health System, Sixth Avenue and Spruce Street, West Reading, Pennsylvania, USA.
Department of Internal Medicine, Reading Health System, Sixth Avenue and Spruce Street, West Reading, Pennsylvania, USA.
BMJ Case Rep. 2017 Jan 20;2017:bcr2016218385. doi: 10.1136/bcr-2016-218385.
We describe a case of 40-year-old woman who presented to our hospital with symptoms of non-radiating epigastric pain for 4-5 days associated with nausea and vomiting. Her history was significant for asthma with recurrent exacerbations, polyneuropathy and recurrent sinus infections. Liver function tests revealed cholestasis. Antinuclear antibody and antismooth muscle cell antibody were positive. Liver biopsy revealed active chronic hepatitis with cholestasis. A diagnosis of autoimmune hepatitis was made. All other causes of cholestatic jaundice were ruled out. Her history of recurrent asthma exacerbations, eosinophilia, recurrent sinus infections and positive myeloperoxidase antibodies was suggestive of eosinophilic granulomatosis with polyangiitis. She was found to have combination of autoimmune hepatitis and eosinophilic granulomatosis with polyangiitis, a rarely reported association in the medical literature. She was started on prednisone for her autoimmune hepatitis. On follow-up with her gastroenterologist, her transaminases were trending down and she was symptomatically better.
我们描述了一例40岁女性，她因上腹部非放射性疼痛4 - 5天并伴有恶心、呕吐前来我院就诊。她有哮喘病史，反复发作，还有多发性神经病和复发性鼻窦感染病史。肝功能检查显示胆汁淤积。抗核抗体和抗平滑肌细胞抗体呈阳性。肝活检显示为伴有胆汁淤积的活动性慢性肝炎。诊断为自身免疫性肝炎。排除了胆汁淤积性黄疸的所有其他病因。她复发性哮喘加重、嗜酸性粒细胞增多、复发性鼻窦感染以及髓过氧化物酶抗体阳性的病史提示为嗜酸性肉芽肿性多血管炎。发现她患有自身免疫性肝炎和嗜酸性肉芽肿性多血管炎的组合，这在医学文献中是一种罕见报道的关联。她开始接受泼尼松治疗自身免疫性肝炎。在随访胃肠病专家时，她的转氨酶呈下降趋势，症状也有所好转。
