Recurrent episodes of acute hepatitis associated with LKM-1 (cytochrome P450 2D6) antibodies in identical twin brothers.
OBJECTIVE
Liver/kidney microsomal antibodies have been noted in liver disease of different etiology, e.g. in autoimmune hepatitis, chronic hepatitis C and D virus infection and in drug-induced liver disease. Unlike these, acute hepatitis of unknown etiology associated with high-titer liver/kidney microsomal-1 antibodies (cytochrome P450 2D6) is reported in identical twin brothers.


METHODS
Patients were studied using clinical, biochemical, serological and immunological methods, as well as liver biopsy.


RESULTS
The acute icteric episodes were followed by spontaneous remission with complete normalization of liver function tests and liver histology. During the acute phase, serum titer for liver/kidney microsomal-1 antibodies (detected by indirect immunofluorescence, ELISA and Western blot analysis) was exceedingly high and decreased gradually thereafter. Hepatitis C and D virus infection were excluded by repeated serological testing; exposure to drugs or chemicals was not evident. Concomitant autoimmune disease was not detectable. HLA typing for class 1 and 2 antigens was positive for the HLA haplotype DQ2, but negative for HLA B4, B8, DR3 and DR4.


CONCLUSIONS
The present observations might suggest a hitherto unreported form of acute hepatitis of unknown etiology, distinct from other liver diseases in which liver/kidney microsomal antibodies have been described so far.
Nolte
W
W
Departments of Medicine, Georg-August-Universität, Göttingen, Germany.
Polzien
F
F
Sattler
B
B
Ramadori
G
G
Hartmann
H
H
D000208:Acute Disease; D000328:Adult; D001323:Autoantibodies / Q000097:blood*; D019389:Cytochrome P-450 CYP2D6; D003577:Cytochrome P-450 Enzyme System / Q000276:immunology*; D004200:Diseases in Twins; D006505:Hepatitis / Q000209:etiology / Q000276:immunology*; D006801:Humans; D008297:Male; D006899:Mixed Function Oxygenases / Q000276:immunology*; D012008:Recurrence
D001323:Autoantibodies; C060729:anti-liver kidney microsome antibody; D003577:Cytochrome P-450 Enzyme System; D006899:Mixed Function Oxygenases; D019389:Cytochrome P-450 CYP2D6