Autoimmune hepatitis in a genetically susceptible patient: is it triggered by acute viral hepatitis A?
The pathogenic mechanisms for autoimmune hepatitis (AIH) are not completely known. Susceptibility to AIH is associated with the human leukocyte antigens (HLA) class II: DR3 and DR4. Nevertheless, AIH does not have a strong genetic predisposition, suggesting that other factors are involved. Perhaps the strongest evidence of a viral cause for AIH exists for hepatitis C virus. AIH has been reported to develop rarely after acute infection with hepatitis A virus. We report on a 55-year-old woman in whom AIH developed during the convalescence period of serologically proven acute viral hepatitis type A. HLA class II DRB1*0401, which was reported to be associated with AIH with a moderate coarse and late appearance in life, was found in this patient. Steroid therapy was followed by a complete clinical remission. Our case supports the possibility that acute hepatitis A may trigger the development of AIH in a genetically susceptible subject.
Hilzenrat
N
N
Department of Gastroenterology, Soroka Medical Center, Ben-Gurion University, Beer-Sheva, Israel.
Zilberman
D
D
Klein
T
T
Zur
B
B
Sikuler
E
E
D000208:Acute Disease; D005260:Female; D020022:Genetic Predisposition to Disease; D006680:HLA Antigens / Q000032:analysis; D006683:HLA-DQ Antigens / Q000032:analysis; D006684:HLA-DR Antigens / Q000032:analysis; D006506:Hepatitis A / Q000276:immunology*; D019693:Hepatitis, Autoimmune / Q000235:genetics* / Q000276:immunology; D006801:Humans; D008875:Middle Aged
D006680:HLA Antigens; D006683:HLA-DQ Antigens; D006684:HLA-DR Antigens