Morihisa Yoshiki, Chung Hobyung, Towatari Shuichiro, Yamashita Daisuke, Inokuma Tetsuro
Department of Gastroenterology and Hepatology, Kobe City Medical Center General Hospital, Kobe 650-0047, Hyogo, Japan.
Department of Pathology, Kobe City Medical Center General Hospital, Kobe 650-0047, Hyogo, Japan.
World J Hepatol. 2024 Feb 27;16(2):286-293. doi: 10.4254/wjh.v16.i2.286.
Chronic hepatitis C virus (HCV) infection is a major global health concern that leads to liver fibrosis, cirrhosis, and cancer. Regimens containing direct-acting antivirals (DAAs) have become the mainstay of HCV treatment, achieving a high sustained virological response (SVR) with minimal adverse events.
A 74-year-old woman with chronic HCV infection was treated with the DAAs ledipasvir, and sofosbuvir for 12 wk and achieved SVR. Twenty-four weeks after treatment completion, the liver enzyme and serum IgG levels increased, and antinuclear antibody became positive without HCV viremia, suggesting the development of autoimmune hepatitis (AIH). After liver biopsy indicated AIH, a definite AIH diagnosis was made and prednisolone was initiated. The treatment was effective, and the liver enzyme and serum IgG levels normalized. However, multiple strictures of the intrahepatic and extrahepatic bile ducts with dilatation of the peripheral bile ducts appeared on magnetic resonance cholangiopancreatography after 3 years of achieving SVR, which were consistent with primary sclerosing cholangitis.
The potential risk of developing autoimmune liver diseases after DAA treatment should be considered.
慢性丙型肝炎病毒（HCV）感染是一个全球主要的健康问题，可导致肝纤维化、肝硬化和癌症。包含直接抗病毒药物（DAA）的治疗方案已成为HCV治疗的主要手段，能实现高持续病毒学应答（SVR）且不良事件极少。
一名74岁慢性HCV感染女性接受了12周的DAA药物来迪派韦和索磷布韦治疗并实现了SVR。治疗结束24周后，肝酶和血清IgG水平升高，抗核抗体呈阳性，且无HCV病毒血症，提示自身免疫性肝炎（AIH）的发生。肝活检提示AIH后，确诊为AIH并开始使用泼尼松龙治疗。治疗有效，肝酶和血清IgG水平恢复正常。然而，在实现SVR 3年后，磁共振胰胆管造影显示肝内和肝外胆管多处狭窄并伴有外周胆管扩张，这与原发性硬化性胆管炎相符。
应考虑DAA治疗后发生自身免疫性肝病的潜在风险。
