title: Fulminant hepatic failure as the initial presentation of acute autoimmune hepatitis.
abstract: OBJECTIVE
  Autoimmune hepatitis is a common cause of chronic hepatitis, and acute presentation is thought to be uncommon. The aim of this study was to compare clinical, biochemical, and histological features in patients with autoimmune hepatitis presenting with either acute or chronic hepatitis.
  
  
  METHODS
  Retrospective review of all patients with autoimmune hepatitis presenting to a University medical center from 1993 to 2002.
  
  
  RESULTS
  One hundred fifteen patients with autoimmune hepatitis were identified. Ten patients with autoimmune hepatitis were identified as having acute presentation (group I), and 20 patients with a classic presentation as chronic hepatitis (group II) served as age- and sex-matched controls. All patients met criteria published by the International Autoimmune Hepatitis Group. Patients with acute presentation differed significantly with regard to encephalopathy, albumin levels, and bilirubin levels. Blinded liver biopsy review demonstrated that those with acute presentation had significantly less fibrosis, and significantly greater interface hepatitis, lobular disarray, lobular hepatitis, hepatocyte necrosis, zone III necrosis, and submassive necrosis.
  
  
  CONCLUSIONS
  In our study, patients with an acute presentation of autoimmune hepatitis differed from patients with a classical presentation clinically, biochemically, and histologically. In our review, a majority of patients with acute autoimmune hepatitis presented with fulminant hepatic failure. The pattern of zone 3 necrosis may be a specific finding in those with acute autoimmune hepatitis.
authors.affiliation: Department of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, 46202, USA.
authors.forename: William R
authors.initials: WR
authors.lastname: Kessler
authors.forename: Oscar W
authors.initials: OW
authors.lastname: Cummings
authors.forename: George
authors.initials: G
authors.lastname: Eckert
authors.forename: Naga
authors.initials: N
authors.lastname: Chalasani
authors.forename: Lawrence
authors.initials: L
authors.lastname: Lumeng
authors.forename: Paul Y
authors.initials: PY
authors.lastname: Kwo
mesh_terms: D000208:Acute Disease; D000328:Adult; D001707:Biopsy, Needle; D002908:Chronic Disease; D003131:Combined Modality Therapy / Q000379:methods; D003937:Diagnosis, Differential; D005260:Female; D019693:Hepatitis, Autoimmune / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D006801:Humans; D007150:Immunohistochemistry; D017093:Liver Failure / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D011336:Probability; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome