title: Autoimmune hepatitis with acute presentation in Japan.
abstract: BACKGROUND
  In Caucasians with autoimmune hepatitis, patients with acute presentation have autoimmune thyroiditis and histological zone 3 necrosis more frequently.
  
  
  OBJECTIVE
  We aimed at investigating clinical features of Japanese autoimmune hepatitis patients with acute presentation.
  
  
  METHODS
  Of 176 patients retrospectively reviewed, 53 were diagnosed with acute presentation.
  
  
  RESULTS
  Patients with acute presentation had higher serum levels of bilirubin and transaminase, lower frequencies of autoimmune thyroiditis and antinuclear antibodies of 1:160 or greater, and a higher frequency of zone 3 necrosis. Of the 53 patients with acute presentation, 10 showed histological acute hepatitis; however, advanced staging of fibrosis was found in 13 patients. In patients with acute presentation, those with histological acute hepatitis were younger than those with chronic hepatitis. The cumulative incidental rate of the normalization of serum alanine aminotransferase levels with prednisolone treatment was similar between patients with acute presentation and those with classical presentation.
  
  
  CONCLUSIONS
  In line with previous results, zone 3 necrosis is a histological characteristic of autoimmune hepatitis with acute presentation. Autoimmune hepatitis with acute presentation includes not only histological acute hepatitis but also acute exacerbation of pre-existing chronic disease. On the other hand, Japanese patients with acute presentation may also have different clinical features from Caucasian patients.
authors.affiliation: Department of Molecular Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. miyakeyasuhiro@hotmail.com
authors.forename: Y
authors.initials: Y
authors.lastname: Miyake
authors.forename: Y
authors.initials: Y
authors.lastname: Iwasaki
authors.forename: H
authors.initials: H
authors.lastname: Kobashi
authors.forename: T
authors.initials: T
authors.lastname: Yasunaka
authors.forename: F
authors.initials: F
authors.lastname: Ikeda
authors.forename: A
authors.initials: A
authors.lastname: Takaki
authors.forename: K
authors.initials: K
authors.lastname: Yamamoto
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D000974:Antibodies, Antinuclear / Q000097:blood; D001663:Bilirubin / Q000097:blood; D005260:Female; D015804:HLA-DR4 Antigen; D019693:Hepatitis, Autoimmune / Q000097:blood* / Q000453:epidemiology / Q000473:pathology*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000974:Antibodies, Antinuclear; D015804:HLA-DR4 Antigen; D000410:Alanine Transaminase; D001663:Bilirubin