Two cases of autoimmune hepatitis in elderly women with positive HLA-DR2 and negative HLA-DR4

The first case was a 76-year-old female, who was admitted to our hospital because of liver dysfunction. Her past medical history was not remarkable except an admission to another hospital two years ago for the diagnosis of acute hepatitis. Her laboratory data were as follows: GOT (AST) 755 U/l, GPT (ALT) 902 U/l, total bilirubin 2.9mg/dl, IgG 3230mg/dl, antinuclear antibody >×5120, LE cell and anti-smooth muscle antibody were negative. Neither HBsAg nor HCV-RNA were detected. HLA-A2, A24(9), B35, B52(5), DR12(5), DR2 were positive. Histological examination of the liver revealed active cirrhosis and plasma cell infiltration. The diagnosis of autoimmune hepatitis was made, and corticosteroid therapy was effective. The second case was a 78-year-old female, who was admitted to our hospital because of the first episode of liver dysfunction. Her laboratory data were as follows: GOT (AST) 246 U/l, GPT (ALT) 152 U/l, total hilirubin 1.7mg/dl, IgG 3050 mg/dl, antinuclear antibody >×1280, LE cell was positive, and anti-smooth muscle antibody was ×80. Neither HBsAg nor HCV-RNA were detected. HLA-A2, A11, B51, B62, Cw1, DR2, DR5, DRw52, DQw1, DQw3 were positive. Histological examination of the liver revealed chronic aggressive hepatitis and plasma cell infiltration. The diagnosis of autoimmune hepatitis was made, and corticosteroid therapy was effective. In Japanese patients with autoimmune hepatitis, a strong association with HLA-DR4 has been established. However, few reports have documented the association between autoimmune hepatitis and HLA-DR2. The presently reported two cases are suggested to demonstrate a close association between elderly-onset cases of Japanese autoimmune hepatitis and HLA-DR2.