title: Precise histological evaluation of liver biopsy specimen is indispensable for diagnosis and treatment of acute-onset autoimmune hepatitis.
abstract: BACKGROUND
  The diagnosis of acute-onset autoimmune hepatitis (AIH) has been difficult because patients do not always show clinicopathological features typical of AIH. We examined the important requirements for a definitive diagnosis of acute-onset AIH.
  
  
  METHODS
  Clinical, biochemical, and pathological features of 18 acute-onset AIH patients (16 women, 2 men; mean age, 54.3 +/- 12.3 years) with no history of liver disease and no signs of chronicity were examined.
  
  
  RESULTS
  Mean ALT was 679 +/- 431 IU/l, and mean T-Bil was 2.4 +/- 2.9 mg/dl. Mean IgG was 1801 +/- 446 mg/dl, with 7 patients (39%) showing normal levels. Antinuclear antibody was <or=1: 40 in 7 (39%). Liver histology showed severe activity in 17 (94%) of the patients and severe acute hepatitis in 7 (39%). Centrizonal necrosis and plasma cell accumulation were characteristic for acute-onset AIH. AIH score ranged from 7 to 18 (13.2 +/- 3.8) before treatment. All patients were diagnosed and treated early and responded completely to therapy.
  
  
  CONCLUSIONS
  Histological examination of the liver is necessary for early diagnosis of acute-onset AIH. Moreover, we should evaluate liver biopsy specimens precisely and should be ready for a timely initiation of corticosteroid therapy to improve the prognosis.
authors.affiliation: Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Fujiwara
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Fukuda
authors.forename: Osamu
authors.initials: O
authors.lastname: Yokosuka
mesh_terms: D000328:Adult; D000368:Aged; D000410:Alanine Transaminase; D000974:Antibodies, Antinuclear / Q000097:blood; D001663:Bilirubin / Q000097:blood; D001707:Biopsy, Needle / Q000379:methods*; D005260:Female; D019693:Hepatitis, Autoimmune / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D008099:Liver / Q000473:pathology*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000175:diagnosis; D011379:Prognosis
chemical_list: D000974:Antibodies, Antinuclear; D007074:Immunoglobulin G; D000410:Alanine Transaminase; D001663:Bilirubin