Successful treatment with interferon for a HCV-RNA positive patient with features of "autoimmune hepatitis"

A case of 55 year-old woman was admitted to our hospital because of general malaise in November 1990. She had episodes of struma and chronic liver disease for last seven years. Two months before admission, serum ALT (SGPT) was elevated to greater than 200 IU per liter. On admission, she was diagnosed as autoimmune hepatitis based on findings of CAH2B with severe plasma cell infiltrasion, an increased level of serum gammaglobulin and high titers of antinuclear antibodies. Her HLA typing was positive for DR4. Corticosteroid therapy was effective to decrease levels of SGPT and gamma globulin. Tapering prednisolone resulted in gradual elevation of SGPT and gammaglobulin levels. Since HCV-RNA was detected positive at this point, administration of interferon-α (6 MU/day) strated. About three months later, SGPT level drastically decreased, and antinuclear antibodies and HCV-RNA became undertectable. Although this case showed characteristics of "autoimmune hepatitis", effectiveness of interferon therapy strongly suggested that HCV played a pathogenic role.