Department of Internal Medicine, Japanese Red Cross Kochi Hospital, Japan.
Department of Diagnostic Pathology, Japanese Red Cross Kochi Hospital, Japan.
Intern Med. 2021 Oct 15;60(20):3231-3237. doi: 10.2169/internalmedicine.7155-21. Epub 2021 Apr 12.
The onset of autoimmune hepatitis (AIH) during pregnancy is rare and often poses a diagnostic challenge. A 29-year-old Japanese woman experienced epigastric pain and nausea during the third trimester of her third pregnancy. Three days after the symptom onset, an emergency Caesarean section was performed because of suspected acute fatty liver of pregnancy; however, the patient's liver dysfunction worsened afterward. Despite normal serum IgG concentration and absence of autoantibodies, biopsy-proven severe hepatitis with centrilobular zonal necrosis and good biochemical response to corticosteroids led to a diagnosis of AIH. Therefore, AIH should be included in the differential diagnosis of liver dysfunction during pregnancy.
自身免疫性肝炎（AIH）在妊娠期间的发病较为罕见，且常常给诊断带来挑战。一位 29 岁的日本女性在第三次妊娠的孕晚期出现上腹痛和恶心。症状出现后 3 天，因疑似妊娠急性脂肪肝行急诊剖宫产术，但此后患者的肝功能恶化。尽管血清 IgG 浓度正常且无自身抗体，但肝活检证实为伴有中-中央带区坏死的重度肝炎，对皮质类固醇治疗的生化应答良好，故诊断为 AIH。因此，AIH 应纳入妊娠期肝功能障碍的鉴别诊断。
