title: Syncytial giant-cell hepatitis due to autoimmune hepatitis type II (LKM1+) presenting as subfulminant hepatitis.
abstract: Giant cell hepatitis (GCH) in adults is a rare event. The diagnosis of GCH is based on findings of syncytial giant hepatocytes. It is commonly associated with either viral infection or autoimmune hepatitis type I. A patient with GCH due to autoimmune hepatitis type II (LKM1+) is described, a combination that has not been previously reported. Corticosteroid therapy was effective in decreasing serum liver enzymes; however, the patient deteriorated rapidly and developed subfulminant hepatic failure. Although an emergency orthotopic liver transplantation was performed, the patient died because of reperfusion injury. Interestingly, only a few giant hepatocytes were noted in the explanted liver. This case stresses the association of GCH with autoimmune disorders, the possible immune mechanism involved in the formation of giant cell hepatocytes, and illustrates the rapidly progressive course and unfavorable prognosis that these patients can develop.
authors.affiliation: Liver Institute, Department of Medicine D, Rabin Medical Center, Petah Tiqva, Israel.
authors.forename: Z
authors.initials: Z
authors.lastname: Ben-Ari
authors.forename: E
authors.initials: E
authors.lastname: Broida
authors.forename: Y
authors.initials: Y
authors.lastname: Monselise
authors.forename: A
authors.initials: A
authors.lastname: Kazatsker
authors.forename: J
authors.initials: J
authors.lastname: Baruch
authors.forename: O
authors.initials: O
authors.lastname: Pappo
authors.forename: E
authors.initials: E
authors.lastname: Skappa
authors.forename: R
authors.initials: R
authors.lastname: Tur-Kaspa
mesh_terms: D000328:Adult; D001323:Autoantibodies / Q000032:analysis*; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D005260:Female; D015726:Giant Cells / Q000473:pathology; D019693:Hepatitis, Autoimmune / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D008099:Liver / Q000473:pathology; D017093:Liver Failure / Q000175:diagnosis* / Q000473:pathology; D008111:Liver Function Tests; D016031:Liver Transplantation; D008875:Middle Aged
chemical_list: D001323:Autoantibodies; C060729:anti-liver kidney microsome antibody