Eosinophilia in autoimmune hepatitis: is there an association?

Mustafa, Ahmad Suhaimi and Tee, Hoi Poh and Che Aun, Azlida and Jaafar, Khairul Azhar and Satwi, Sapari (2011) Eosinophilia in autoimmune hepatitis: is there an association? Medical Journal of Malaysia, 66 (Supp A). p. 10. ISSN 0300-5283

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Abstract

Background: There were several reports on eosinophilic drug-induced hepatitis. We report a case of autoimmune hepatitis (AIH) presenting with eosinophilia in whom steroid therapy induces resolution of both eosnophilia and hepatitis. CASE REPORT: A 57 years old lady who presented with jaundice and right hypochondriac pain associated with tender hepatomegaly and urticarial rash. Blood investigations showed high eosinophil counts persistently ranging from 800 to 1500/mm3 with highly elevated bilirubin of 380 umol/L, alanine transaminase 750 U/L and aspartate transaminase of 1015 U/L. She has raised serum immunoglobulin IgG of 21.6 g/L. Liver biopsy showed moderate interface hepatitis and plasma cells infiltration suggesting AIH. However, her antinuclear antibody was negative. She had negative serology for hepatitis A, B and C and a normal ultrasound abdomen. Definite diagnosis of AIH was made based on Codified Dignostic Criteria of the International Autoimmune Hepatitis Group with aggregate score 17. On starting steroid, she had a complete normalization of liver function and eosinophil production induced by compounds released by basophills and mast cells, including eosinophill chemotactic facotr of anaphylaxis, leukotriene B4, complement complex (C5-C6-C7), interleukin 5, and histamine. AIH is characterized by an inflammation of the portal tract with lymphocytes and plasma cells, hypergammaglobulinemia and presence of a variety of circulatin autoantibodies. While eosionophilia is humoral (antibody-mediated), AIH is characterized by an inflammation of the portal tract with lymphocytes and plasma cells, hypergammaglobulinemia and presence of a varety iof circulatin autoantibodies. While eosionophillia is humoral (antibody-mediated), AIH is thought to be cell-mediated. Presence of both conditions in an individual is uncommon. In this case effort had been maed to rule out other cases of eosinophilia such as drug-induced or helminthic infections but there were all negative. The mechanism of dual-pathology in this case remains unresolved. CONCLUSION: Eosinophilia is not a diagnostic feature for AIH.An association wtih AIH is suggested in this case.

Item Type:	Article (Journal)
Additional Information:	3739/23667
Subjects:	R Medicine > RC Internal medicine
Kulliyyahs/Centres/Divisions/Institutes (Can select more than one option. Press CONTROL button):	Kulliyyah of Medicine > Department of Internal Medicine
Depositing User:	Ms Rosyidah Taju Rahim
Date Deposited:	24 Apr 2012 14:45
Last Modified:	24 Apr 2012 14:49
URI:	http://irep.iium.edu.my/id/eprint/23667

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