A case of autoimmune "lupoid" hepatitis diagnosed at a recurrence 9 years after the onset with a feature resembling acute hepatitis

A 42-year-old female presented with a feature resembling acute hepatitis. Laboratory findings showed no hypergammaglobulinemia. Anti-nuclear antibodies were positive (160×) but anti-smooth muscle antibodies were negative. Anti-HA antibodies (IgG class) were positive but HBV markers negative. Liver biopsy findings were compatible to acute hepatitis with marked centrilobular necrosis. A diagnosis of acute non-A, non-B hepatitis was made. Abnormalities of serum transaminase levels persisted but responded well to prednisolone treatment. Nine years later she admitted again with features similar to the first presentation. Serum tests showed transiently positive LE cell phenomenon and higher ANA titers (640×). Anti-HCV antibodies (second gen.) and HCV RNA were negative. Liver biopsy findings disclosed chronic active hepatitis with piecemeal and centrilobular necrosis. Prednisolone improved serum biochemical and autoantibody abnormalities. Thus, autoimmune hepatitis should be taken into consideration in a differential diagnosis of acute non-A, non-B, non-C hepatitis. Furthermore, diagnostic values of centrilobular necrosis should be evaluated.