title: Prolonged intrahepatic cholestasis in acute-onset, severe autoimmune hepatitis.
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 20 mg/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 Insulin-glucagon therapy was given for normalization of transaminases and then withdrawn 3 weeks after admission, but it was resumed at 3 months, resulting in a dramatic decrease in serum bilirubin levels, which then normalized in 2.5 months.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.
authors.affiliation: Department of Internal Medicine, Cancer Research Institute, Kanazawa University, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Motoo
authors.forename: N
authors.initials: N
authors.lastname: Sawabu
authors.forename: H
authors.initials: H
authors.lastname: Watanabe
authors.forename: T
authors.initials: T
authors.lastname: Okai
authors.forename: Y
authors.initials: Y
authors.lastname: Nakanuma
mesh_terms: D000208:Acute Disease; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001327:Autoimmune Diseases / Q000150:complications* / Q000188:drug therapy; D002780:Cholestasis, Intrahepatic / Q000150:complications* / Q000188:drug therapy; D002908:Chronic Disease; D004359:Drug Therapy, Combination; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D005934:Glucagon / Q000627:therapeutic use; D006505:Hepatitis / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007328:Insulin / Q000627:therapeutic use; D011239:Prednisolone / Q000627:therapeutic use
chemical_list: D000893:Anti-Inflammatory Agents; D005765:Gastrointestinal Agents; D007328:Insulin; D005934:Glucagon; D011239:Prednisolone