Autoimmune cholangitis with features of autoimmune hepatitis: successful treatment with immunosuppressive agents and ursodeoxycholic acid.
We report a 42-year-old Chinese female with elevated serum levels of liver aminotransferases, alkaline phosphatase, gamma-glutamyl transpeptidase, cholesterol and immunoglobulin M. Serum antimitochondrial antibody was negative, but antinuclear antibody was strongly positive. Liver histology showed features of both autoimmune cholangitis and autoimmune hepatitis. Combination therapy with immunosuppressive (prednisone and azathioprine) and choleuretic agents (ursodeoxycholic acid) was given. Serum aminotransferases and biliary enzymes showed much improvement after treatment. A follow-up liver biopsy showed improvement of both hepatic necroinflammation and bile duct damage. Biliary enzymes rose after withdrawal of the immunosuppressive agents and declined again with reinstitution of prednisone. This case demonstrates that a combination of immunosuppressive agents and ursodeoxycholic acid may effectively treat patients with features of both autoimmune cholangitis and autoimmune hepatitis.
Li
C P
CP
Department of Medicine, Veterans General Hospital-Taipei, National Yang-Ming University School of Medicine, Taiwan, Republic of China.
Tong
M J
MJ
Hwang
S J
SJ
Luo
J C
JC
Co
R L
RL
Tsay
S H
SH
Chang
F Y
FY
Lee
S D
SD
D000328:Adult; D000974:Antibodies, Antinuclear / Q000097:blood; D001327:Autoimmune Diseases / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D001706:Biopsy; D002756:Cholagogues and Choleretics / Q000627:therapeutic use*; D002761:Cholangitis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D005260:Female; D019693:Hepatitis, Autoimmune / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008099:Liver / Q000473:pathology; D000637:Transaminases / Q000097:blood; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use*
D000974:Antibodies, Antinuclear; D002756:Cholagogues and Choleretics; D007166:Immunosuppressive Agents; D014580:Ursodeoxycholic Acid; D000637:Transaminases