Autoimmune chronic active hepatitis associated with the presence of antiphospholipid antibodies.
We report a patient with clinical, biochemical and immunological indices suggestive of autoimmune hepatitis with marked transaminasaemia, raised immunoglobulins and positive anti-nuclear and anti-smooth muscle antibodies. A coagulation screen revealed a transient, markedly increased, activated, partial thromboplastin time and a normal prothrombin time, with elevated levels of anticardiolipin antibodies and the presence of lupus anticoagulant, indicating the presence of antiphospholipid antibodies. Subsequent histology confirmed moderate hepatitis with piecemeal necrosis and fibrosis. Appropriate autoimmune therapy was commenced. This presentation illustrates the rare association of anti-phospholipid antibodies with autoimmune chronic active hepatitis presenting with a temporarily abnormal coagulation screen.
Pathmakanthan
S
S
Department of Hepatology, Beaumont Hospital, Dublin, Ireland.
Kay
E W
EW
Murray
F E
FE
D000199:Actins / Q000276:immunology / Q000378:metabolism; D000328:Adult; D017153:Antibodies, Anticardiolipin / Q000097:blood; D000974:Antibodies, Antinuclear / Q000097:blood; D017152:Antibodies, Antiphospholipid / Q000097:blood*; D016736:Antiphospholipid Syndrome / Q000097:blood / Q000150:complications* / Q000378:metabolism; D019693:Hepatitis, Autoimmune / Q000150:complications / Q000276:immunology* / Q000378:metabolism / Q000473:pathology; D006801:Humans; D016682:Lupus Coagulation Inhibitor / Q000097:blood; D008297:Male; D010314:Partial Thromboplastin Time; D011517:Prothrombin Time; D012155:Reticulin / Q000378:metabolism
D000199:Actins; D017153:Antibodies, Anticardiolipin; D000974:Antibodies, Antinuclear; D017152:Antibodies, Antiphospholipid; D016682:Lupus Coagulation Inhibitor; D012155:Reticulin