Clinical characteristics of fulminant-type autoimmune hepatitis: an analysis of eleven cases.
BACKGROUND
Although a few adult cases of fulminant-type autoimmune hepatitis have been reported, their clinical features and prognosis have remained uncertain.


OBJECTIVE
To assess the clinical features and prognosis of patients with fulminant-type autoimmune hepatitis.


METHODS
Eleven patients (10%) diagnosed with fulminant-type autoimmune hepatitis in accordance with the 1999 criteria of the International Autoimmune Hepatitis Group were analysed.


RESULTS
All 11 patients were female, with a median age of 53 years. Five patients survived without liver transplantation, one received a liver transplantation, and five died without liver transplantation. Nine patients (82%) survived for 2 weeks or more following diagnosis, without liver transplantation. Except for the patient receiving a liver transplantation, serum total bilirubin levels measured during the clinical course were significantly higher in non-survivors than in survivors, although the accompanying serum alanine aminotransferase levels measured for the two groups were similar. Most significantly, serum total bilirubin levels in non-survivors worsened during days 8-15, while levels in survivors improved during the same period.


CONCLUSIONS
The short-term prognosis for patients with fulminant-type autoimmune hepatitis may be good. However, patients whose serum total bilirubin levels worsen during days 8-15 should be considered for liver transplantation.
Miyake
Y
Y
Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. miyakeyasuhiro@hotmail.com
Iwasaki
Y
Y
Terada
R
R
Onishi
T
T
Okamoto
R
R
Sakai
N
N
Sakaguchi
K
K
Shiratori
Y
Y
D000293:Adolescent; D000328:Adult; D000368:Aged; D001663:Bilirubin / Q000097:blood; D017809:Fatal Outcome; D005260:Female; D019693:Hepatitis, Autoimmune / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D017093:Liver Failure / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D016031:Liver Transplantation; D008875:Middle Aged; D011379:Prognosis
D001663:Bilirubin