Dohmen K, Ohtsuka S, Nakamura H, Arase K, Yokogawa Y, Asayama R, Kuroiwa S, Ishibashi H
Department of Internal Medicine, Hamanomachi General Hospital, Fukuoka, Japan.
J Gastroenterol. 1994 Jun;29(3):362-8. doi: 10.1007/BF02358378.
A 69-year-old Japanese female was admitted because of general fatigue. Laboratory data showed elevation of serum total bilirubin, transaminase, gamma-glutamyl transpeptidase, and creatinine levels. An immunological study revealed hypergammaglobulinemia, low titer of complement, and high titers of antinuclear antibody, anti-DNA antibody, and circulating immune complexes. Antibodies to parainfluenza virus 3 were positive. Histology of the liver disclosed numerous giant cell hepatocyte transformations with the lobular architecture being slightly distorted by portal inflammation and fibrosis. These findings led us to make a diagnosis of giant cell hepatitis associated with systemic lupus erythematosus. Prednisolone was effective in improving the anemia and the serum immunoglobulin, immune complex, and antinuclear antibody levels. The addition of cyclosporine to the initial corticosteroid therapy was also beneficial in decreasing the transaminase level and in improving liver histology. The patient died of acute pneumonitis and renal failure on the 166th day after admission. Parainfluenza virus 3 and autoimmune mechanisms were thus considered to be the causes of the giant cell hepatitis.
一名69岁的日本女性因全身乏力入院。实验室检查数据显示血清总胆红素、转氨酶、γ-谷氨酰转肽酶和肌酐水平升高。免疫学研究显示高球蛋白血症、低滴度补体以及高滴度抗核抗体、抗DNA抗体和循环免疫复合物。抗副流感病毒3抗体呈阳性。肝脏组织学检查发现大量巨细胞肝细胞转化，小叶结构因门静脉炎症和纤维化而略有扭曲。这些发现使我们诊断为与系统性红斑狼疮相关的巨细胞肝炎。泼尼松龙对改善贫血以及血清免疫球蛋白、免疫复合物和抗核抗体水平有效。在初始皮质类固醇治疗中加用环孢素也有助于降低转氨酶水平并改善肝脏组织学。患者在入院第166天死于急性肺炎和肾衰竭。因此，副流感病毒3和自身免疫机制被认为是巨细胞肝炎的病因。
