Acute hepatitis in a young woman with systemic lupus erythematosus: a diagnostic challenge. (5th April 2013)

• Record Type: Journal Article
• Authors: Barosa, Rita; Ramos, Lídia Roque; Fonseca, Cristina; Freitas, João
• Is Part Of: BMJ case reports. Volume 2013
• Publication Date: 2013-04-05
• Subjects: Medicine -- Case studies -- Periodicals; 610.5
• DOI: 10.1136/bcr-2013-008591
• Languages: English
• ISSNs: 1757-790X

Abstract

Abstract : A 48-year-old woman with systemic lupus erythematosus diagnosis was on naproxen, hidroxichloroquine and acetylsalicylic acid. She had self-suspended all medication and resumed 1 year later. Five days after the medication was resumed, she developed acute hepatitis, with biochemical hepatic cytolysis, hypergamaglobulinaemia and a serum antinuclear antibody titre of 1/2560. Idiopathic autoimmune hepatitis was considered, but drug-induced liver injury could not definitely be ruled out. Patient declined liver biopsy. Oral prednisolone was started. Within 3 months with prednisolone being tapered to 10 mg/day, a new flare occurred. Liver biopsy was performed and it favoured autoimmune hepatitis diagnosis. We discuss the diagnostic options and treatment approach in a patient with autoimmune disease and possible drug-induced liver injury who initially declined liver biopsy.