Abstract
A 72-year-old woman was admitted because of jaundice and hepatocellular dysfunction. She was diagnosed with autoimmune hepatitis from laboratory test results showing high titers of antinuclear antibodies and negativity for hepatitis viral markers. Steroid i.v. pulse therapy and oral administration of prednisolone were effective in improving the liver function test results, except for hyperbilirubinemia. Elevated serum bilirubin levels, of approximately 20mg/dl persisted for more than 6 months, despite the administration of ursodeoxycholic acid. Insulin-glucagon therapy was given for normalization of transaminases and then withdrawn 3 weeks after admission, but it was resumed at 3 months, resulting in a dramatic decrease in serum bilirubin levels, which then normalized in 2.5 months. Liver biopsy 6 months after onset showed chronic active hepatitis with bile plugs. Insulin-glucagon therapy, because of its choleretic effect, may be worth continuing even after recovery of acute hepatic failure.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Crapper RM, Bhathal PS, Mackay IR, et al. “Acute” autoimmune hepatitis. Digestion 1986;34:216–225
Matsushita E, Unoura M, Furusawa A, et al. Study of the mechanisms of development of autoimmune hepatitis (in Japanese with English abstract). Acta Hepat Jpn 1988;29:1357–1361.
Kamiyama T, Izumi N, Kojima S, et al. A case of early autoimmune chronic active hepatitis with clinically acute onset and histological features of acute hepatitis. (in Japanese with English abstract). Acta Hepat Jpn 1990;31:565–569.
Morimoto H, Wakabayashi T, Suzuki K, et al. Autoimmune hepatitis manifested by clinico-pathological features of acute hepatitis: Report of two cases (in Japanese with English abstract). Acta Hepat Jpn 1991;32:1148–1155.
Kuramitsu T, Komatsu M, Ono T, et al. A rare case of autoimmune hepatitis with acute onset (in Japanese with English abstract). Akita J Med 1993;20:467–471.
Takamura H, Endo M, Hiranuma M, et al. A case of rapid progress of autoimmune hepatitis in a male of middle age (in Japanese with English abstract). J Nihon Univ Med Assoc 1990;49:983–988.
Lefkowitch JH, Apfelbaum TF, Weinberg L, et al. Acute liver biopsy lesions in early autoimmune (“lupoid”) chronic active hepatitis. Liver 1984;4:379–386.
Amontree JS, Stuart TD, Bredffeldt JE. Autoimmune chronic active hepatitis masquerading as acute hepatitis. J Clin Gastroenterol 1989;11:303–307.
Porta G, Gayotto LCC, Alvarez F. Anti-liver-kidney microsome antibody-positive autoimmune hepatitis presenting as fulminant liver failure. J Pediatr Gastroenterol Nutr 1990;11:138–140.
Sekine K, Saito T, Watanabe H, et al. A patient with fulminant course of lupoid hepatitis improved by plasmapheresis and steroid pulse therapy (in Japanese with English abstract). Gastroenterology (Tokyo) 1990;12:114–119.
Nakadate I, Nakamura A, Endo R, et al. Autoimmune hepatitis presenting with acute hepatic failure (in Japanese with English abstract). Acta Hepat Jpn 1993;34:665–671.
Ohnishi K, Torimoto Y, Ohhira M, et al. A patient with autoimmune hepatitis recovered from fulminant-like severe hepatic failure (in Japanese). Jpn J Gastroenterol 1994;91:1457–1463.
Sherlock S, Dooley J. Diseases of the liver and biliary system. 9th ed. Oxford: Blackwell Scientific Publications 1993:266–268.
Okita K, Matsuda S, Hata K, et al. Clinical use of glucagon and insulin in therapy of fulminant hepatic failure. Gastroenterol Jpn 1979;14:453–457.
Johnson PJ, McFarlane IG. Meeting report: International autoimmune hepatitis group. Hepatology 1993;18:998–1005.
Nakanuma Y, Harada K, Nonomura A, et al. Pathology of autoimmune hepatitis and related diseases. In: Nishioka M, Toda G, Zeniya M, (eds). Autoimmune hepatitis. Amsterdam: Elsevier Science, 1994:85–127.
Vento S, Garofano T, Di Perri G, et al. Identification of hepatitis A virus as a trigger for autoimmune chronic hepatitis type 1 in susceptible individuals. Lancet 1991;337:1183–1187.
Rahaman SM, Chira P, Koff RS. Idiopathic autoimmune chronic hepatitis triggered by hepatitis A. Am J Gastroenterol 1994;89: 106–108.
Laskus T, Slusarczyk J. Autoimmune chronic active hepatitis developing after acute type B hepatitis. Dig Dis Sci 1989;34:1294–1297.
Taylor SL, Dean PJ, Riely CA. Primary autoimmune cholangitis: An alternative to antimitochondrial antibody-negative primary biliary cirrhosis. Am J Surg Pathol 1994;18:91–99.
Colombato LA, Alvarez F, Cote J, et al. Autoimmune cholangiopathy: The result of consecutive primary biliary cirrhosis and autoimmune hepatitis?. Gastroenterology 1994;107:1839–1843.
Michieletti P, Wanless IR, Katz A, et al. Antimitochondrial antibody-negative primary biliary cirrhosis: A distinct syndrome of autoimmune cholangitis. Gut 1994;35:260–265.
Farivar M, Wands JR, Isselbacher KJ, et al. Effect of insulin and glucagon on fulminant murine hepatitis. N Engl J Med 1967;295:1517–1523.
Moris TQ. Choleretic responses to cyclic AMP and theophylline in the dog (abstract). Gastroenterology 1972;62:187.
Kaminski DL, Ruwart MJ, Jellinek M. Effect of glucagon on secretin-stimulated bile flow. Am J Physiol 1975;229:1480–1485.
Yano T, Noguchi T, Hitaka N, Mizumoto R. Studies on insulin-glucagon therapy for intractable jaundice in surgical patients. Mie Med J 1983;33:217–24.
Suzuki K, Katoh A, Sasaki K, et al. A case of Zieve's syndrome which was improved by glucagon-insulin therapy (in Japanese). Kan Tan Sui (J Bil Pancreas) 1987;14:979–984.
Lebovics E, Schaffner F, Klion FM, et al. Autoimmune chronic active hepatitis in postmentopausal women. Dig Dis Sci 1985;30: 824–828.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Motoo, Y., Sawabu, N., Watanabe, H. et al. Prolonged intrahepatic cholestasis in acute-onset, severe autoimmune hepatitis. J Gastroenterol 32, 410–413 (1997). https://doi.org/10.1007/BF02934502
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02934502