Abstract
We describe the clinical course of a group ofpatients with primary sclerosing cholangitis who atpresentation were diagnosed to have autoimmunehepatitis. The history of one such patient is describedin detail. We also compare this atypicalsclerosing cholangitis (group I) to typical sclerosingcholangitis (group II) and to autoimmune hepatitis with(group III) and without (group IV) cholestasis. Atpresentation, mean AST in groups I and III was similar andsignificantly higher than in group II (P < 0.05).Mean ALP was higher in sclerosing cholangitis than inautoimmune hepatitis but not significantly so. Triaditis was present in all patients in groups I, III,and IV. Piecemeal necrosis and multilobularcollapse/fibrosis were equally frequent in groups I,III, and IV. Only the response to corticosteroids helpeddifferentiate among groups. Groups III and IV responded bynormalizing AST. In group I, AST improved, but neverbecame normal. As ALP became disproportionately abnormal(ALP-predominant pattern), cholangiography was performed, and the diagnosis of primarysclerosing cholangitis was made in all group I patients.We recommend that cholangiography be performed early inpatients with suspected autoimmune hepatitis who partially respond to corticosteroids anddevelop an ALP-predominant pattern.
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REFERENCES
Krawitt EL, Albertini RJ: Immunogenetic studies of autoimmune liver diseases. In Autoimmune Liver Diseases. EL Krawitt, RH Wiesner (eds). New York, Raven Press, 1991, pp 63-73
Chapman RW: Role of immune factors in the pathogenesis of primary sclerosing cholangitis. Semin Liver Dis 11:1-4, 1991
Targan SR, Landers C, Vidrich A, Czaja AJ: High-titer antineutrophil cytoplasmic antibodies in type-1 autoimmune hepatitis. Gastroenterology 108:1159-1166, 1995
Duerr RH, Targan SR, Landers CJ, LaRusso NF, Lindsay KL, Wiesner RH, Shanahan F: Neutrophil cytoplasmic antibodies: A link between primary sclerosing cholangitis and ulcerative colitis. Gastroenterology 100:1385-1391, 1991
LaRusso NF, Wiesner RH, Ludwig J, MacCarty RL: Primary sclerosing cholangitis. N Engl J Med 310:899-903, 1984
Desmet VJ, Gerber M, Hoofnagle JH, Manns M, Scheuer PJ: Classification of chronic hepatitis: Diagnosis, grading and staging. Hepatology 19:1513-1510, 1994
Czaja AJ: Natural history, clinical features, and treatment of autoimmune hepatitis. Semin Liver Dis 4:1-12, 1984
Klatskin G, Conn HO: Histopathology of the Liver, Vol I. New York, Oxford University Press, 1993, pp 68-69
Johnson PJ, McFarlane IJ: International Autoimmune Hepatitis Group: Meeting report. Hepatology 18:998-1005, 1993
Ben-Ari Z, Dhillon AP, Sherlock S: Autoimmune cholangiopathy: Part of the spectrum of autoimmune chronic active hepatitis. Hepatology 18:10-15, 1993
Michieletti P, Wanless IR, Katz A, Scheuer PJ, Yeaman SJ, Bassendine MF, Palmer JM, Heathcote EJ: Antimitochondrial antibody negative primary biliary cirrhosis: A distinct syndrome of autoimmune cholangitis. Gut 35:260-265, 1994
Taylor SL, Dean PJ, Rieley CA: Primary autoimmune cholangitis: An alternative to antimitochondrial antibody-negative primary biliary cirrhosis. Am J Clin Pathol 18:91-99, 1994
Wang KK, Czaja AJ: Prognosis of corticosteroid-treated hepatitis B surface antigen-negative chronic active hepatitis in postmenopausal women: A retrospective analysis. Gastroenterology 97:1288-1293, 1989
Lindor KD, Wiesner RH, Colwell LJ, Steiner B, Beaver S, LaRusso NF: The combination of prednisone and colchicine in patients with primary sclerosing cholangitis. Am J Gastroenterol 85:57-61, 1991
Narumi S, Roberts JP, Emond JC, Lake J, Ascher NL: Liver transplantation for sclerosing cholangitis. Hepatology 22:451-457, 1995
Rabinovitz M, Demetris AJ, Bou-Aboud CF, Van Thiel DH: Simultaneous occurrence of primary sclerosing cholangitis and autoimmune chronic active hepatitis in a patient with ulcerative colitis. Dig Dis Sci 37:1606-1611, 1992
Perdigoto R, Carpenter HA, Czaja AJ: Frequency and significance of chronic ulcerative colitis in severe corticosteroid-treated autoimmune hepatitis. J Hepatol 14:325-331, 1992
Kaplan MM: Medical approaches to primary sclerosing cholangitis. Semin Liver Dis 11:56-63, 1991
Czaja AJ: Autoimmune hepatitis: Evolving concepts and treatment strategies. Dig Dis Sci 40:435-456, 1995
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Luketic, V.A., Gomez, D.A., Sanyal, A.J. et al. An Atypical Presentation for Primary Sclerosing Cholangitis. Dig Dis Sci 42, 2009–2016 (1997). https://doi.org/10.1023/A:1018845829198
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DOI: https://doi.org/10.1023/A:1018845829198