Journal of Gastroenterology

, Volume 32, Issue 5, pp 689–695 | Cite as

Exacerbated autoimmune hepatitis successfully treated with leukocytapheresis and bilirubin adsorption therapy

  • Koji Sawada
  • Kunio Ohnishi
  • Tadashi Kosaka
  • Shinji Chikano
  • Akimitsu Egashira
  • Masanori Okui
  • Shigeyuki Shintani
  • Masaaki Wada
  • Keiji Nakasho
  • Takashi Shimoyama
Case Report

Abstract

A 58-year-old man with subacute fulminant onset of autoimmune hepatitis (AIH) was treated by leukocytapheresis (LCAP) and bilirubin adsorption therapy (BAT), rather than by administration of highdose corticosteroids as he had mild glucose intolerance, and a definitive diagnosis of AIH was not obtained on admission; further, there was a risk of viral infection. After initiation of the therapies, serum transaminases and bilirubin, immunoglobulins, anti-nuclear antibodies, and rheumatoid factor decreased rapidly, as did the initially high levels of activated cells and several pro-inflammatory cytokines. Liver inflammation observed on liver biopsy settled during the course of the therapies, with no adverse side effects. A pause in the therapies was associated with deterioration; however, restoration of apheresis was followed by normalization. Remission was sustained throughout the period monitored, except for a recurrence 14 months after discharge, which was successfully resolved by two additional LCAP sessions. These results suggest that LCAP influences the causal mechanism(s) of exacerbation of AIH.

Key words

activated cells cytokines endotoxin 

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Copyright information

© Springer-Verlag 1997

Authors and Affiliations

  • Koji Sawada
    • 1
  • Kunio Ohnishi
    • 1
  • Tadashi Kosaka
    • 1
  • Shinji Chikano
    • 1
  • Akimitsu Egashira
    • 1
  • Masanori Okui
    • 1
  • Shigeyuki Shintani
    • 1
  • Masaaki Wada
    • 1
  • Keiji Nakasho
    • 2
  • Takashi Shimoyama
    • 1
  1. 1.Fourth Department of Internal MedicineHyogo College of MedicineNishinomiya, HyogoJapan
  2. 2.Second Department of PathologyHyogo College of MedicineNishinomiya, HyogoJapan

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