Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Italy; IRCCS-Ospedale Policlinico San Martino, Genoa, Italy.
Pathology Unit, Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Italy; IRCCS-Ospedale Policlinico San Martino, Genoa, Italy.
Ann Hepatol. 2020 Mar-Apr;19(2):222-225. doi: 10.1016/j.aohep.2019.11.006. Epub 2019 Dec 5.
Chronic hepatitis C virus (HCV) infection and autoimmune disorders show a complex interplay, with HCV often being identified as the trigger of autoimmune phenomena or diseases. While there is evidence of successful HCV treatment with direct-acting antivirals (DAA) in patients with concomitant HCV and autoimmune hepatitis (AIH), there are also sparse reports of AIH developing during, or following, DAA treatment. Here we report a case of a patient with suspected concomitant HCV and AIH who underwent liver biopsy but showed no histological hallmarks of autoimmunity. The patient later developed a hepatitic flare following DAA-induced viral clearance, and a second liver biopsy showed features compatible with AIH. Response to corticosteroid and azathioprine treatment was seen. This reports demonstrates that patients with features of auto-reactivity and HCV after DAA-induced viral clearance require careful follow-up.
慢性丙型肝炎病毒（HCV）感染和自身免疫性疾病之间存在着复杂的相互作用，HCV 常被认为是自身免疫现象或疾病的触发因素。虽然有证据表明直接作用抗病毒药物（DAA）可成功治疗同时患有 HCV 和自身免疫性肝炎（AIH）的患者，但也有稀疏的报道称 AIH 在 DAA 治疗期间或之后发生。本文报道了一例疑似同时患有 HCV 和 AIH 的患者，该患者接受了肝活检，但未显示自身免疫的组织学特征。随后，该患者在 DAA 诱导的病毒清除后出现肝炎发作，第二次肝活检显示符合 AIH 的特征。患者对皮质类固醇和硫唑嘌呤治疗有反应。本报告表明，在 DAA 诱导的病毒清除后出现自身反应性和 HCV 特征的患者需要密切随访。
