Exacerbated autoimmune hepatitis successfully treated with leukocytapheresis and bilirubin adsorption therapy.
A 58-year-old man with subacute fulminant onset of autoimmune hepatitis (AIH) was treated by leukocytapheresis (LCAP) and bilirubin adsorption therapy (BAT), rather than by administration of high-dose corticosteroids as he had mild glucose intolerance, and a definitive diagnosis of AIH was not obtained on admission; further, there was a risk of viral infection. After initiation of the therapies, serum transaminases and bilirubin, immunoglobulins, anti-nuclear antibodies, and rheumatoid factor decreased rapidly, as did the initially high levels of activated cells and several pro-inflammatory cytokines. Liver inflammation observed on liver biopsy settled during the course of the therapies, with no adverse side effects. A pause in the therapies was associated with deterioration; however, restoration of apheresis was followed by normalization. Remission was sustained throughout the period monitored, except for a recurrence 14 months after discharge, which was successfully resolved by two additional LCAP sessions. These results suggest that LCAP influences the causal mechanism(s) of exacerbation of AIH.
Sawada
K
K
Fourth Department of Internal Medicine, Hyogo College of Medicine, Japan.
Ohnishi
K
K
Kosaka
T
T
Chikano
S
S
Egashira
A
A
Okui
M
M
Shintani
S
S
Wada
M
M
Nakasho
K
K
Shimoyama
T
T
D000327:Adsorption; D001663:Bilirubin; D001706:Biopsy; D005500:Follow-Up Studies; D019693:Hepatitis, Autoimmune / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D006801:Humans; D007937:Leukapheresis / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012008:Recurrence
D001663:Bilirubin