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Avdyshev V.D.

Sechenov First Moscow State Medical University

Kharlamova A.A.

Sechenov First Moscow State Medical University

Kucher A.E.

Sechenov First Moscow State Medical University

Skosyrskiy V.S.

Sechenov First Moscow State Medical University

Osipova S.V.

Sechenov First Moscow State Medical University

Teplyuk D.A.

Sechenov First Moscow State Medical University;
Botkin Moscow City Hospital

Levina O.N.

Sechenov First Moscow State Medical University

Pavlov Ch.S.

Sechenov First Moscow State Medical University;
Botkin Moscow City Hospital

Autoimmune hepatitis: pitfalls of diagnosis and therapy (clinical case)

Authors:

Avdyshev V.D., Kharlamova A.A., Kucher A.E., Skosyrskiy V.S., Osipova S.V., Teplyuk D.A., Levina O.N., Pavlov Ch.S.

More about the authors

Journal: Russian Journal of Evidence-Based Gastroenterology. 2024;13(4): 95‑103

DOI: 10.17116/dokgastro20241304195

Views: 683

Downloaded: 81

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To cite this article:

Avdyshev VD, Kharlamova AA, Kucher AE, et al. . Autoimmune hepatitis: pitfalls of diagnosis and therapy (clinical case). Russian Journal of Evidence-Based Gastroenterology. 2024;13(4):95‑103. (In Russ.)
https://doi.org/10.17116/dokgastro20241304195

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Autoimmune hepatitis (AIH) is an immune-mediated chronic liver disease that can lead to cirrhosis and its complications. The lack of strict diagnostic criteria for AIH complicates diagnosis and delays the initiation of appropriate therapy. Treatment selection and patient management remain challenges.

OBJECTIVE

To highlight the diagnostic and therapeutic aspects of AIH based on a clinical case.

CLINICAL CASE

A 33-year-old female presented with significant cytolysis and cholestasis. A differential diagnosis ruled out viral hepatitis, liver storage diseases, and drug-induced liver injury (the patient had taken paracetamol and amoxicillin-clavulanate for a recent viral infection). Anti-SLA/LP antibodies were detected, while ANA, AMA, ANCA, SMA, and anti-LKM were within reference ranges. A liver biopsy revealed features of AIH and grade 1 steatosis. The final diagnosis was chronic AIH with high cytolytic activity, intrahepatic cholestasis, and parenchymal jaundice. Immunosuppressive therapy with prednisolone (40 mg/day) and azathioprine (50 mg/day) was initiated, with dosage adjustments for side effects. Despite four years of therapy, full biochemical and morphological remission was not achieved, and the risk of cirrhosis remains. This case underscores the challenges of diagnosing AIH and its potential overlap with cholestatic liver diseases. The article also discusses the need to monitor therapy-related side effects and the role of thiopurine S-methyltransferase testing in treatment.

CONCLUSION

The heterogeneity of AIH symptoms complicates early diagnosis. A comprehensive approach, including autoantibody testing and imaging, is essential for timely and accurate diagnosis.

Keywords:

autoimmune hepatitis
immunosuppressive therapy
liver biopsy
cholestasis
cytolysis

Authors:

Avdyshev V.D.

Sechenov First Moscow State Medical University

Kharlamova A.A.

Sechenov First Moscow State Medical University

Kucher A.E.

Sechenov First Moscow State Medical University

Skosyrskiy V.S.

Sechenov First Moscow State Medical University

Osipova S.V.

Sechenov First Moscow State Medical University

Teplyuk D.A.

Sechenov First Moscow State Medical University;
Botkin Moscow City Hospital

Levina O.N.

Sechenov First Moscow State Medical University

Pavlov Ch.S.

Sechenov First Moscow State Medical University;
Botkin Moscow City Hospital

Received:

20.03.2024

Accepted:

08.10.2024

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