title: Acute hepatitis in a young woman with systemic lupus erythematosus: a diagnostic challenge.
abstract: A 48-year-old woman with systemic lupus erythematosus diagnosis was on naproxen, hidroxichloroquine and acetylsalicylic acid. She had self-suspended all medication and resumed 1 year later. Five days after the medication was resumed, she developed acute hepatitis, with biochemical hepatic cytolysis, hypergamaglobulinaemia and a serum antinuclear antibody titre of 1/2560. Idiopathic autoimmune hepatitis was considered, but drug-induced liver injury could not definitely be ruled out. Patient declined liver biopsy. Oral prednisolone was started. Within 3 months with prednisolone being tapered to 10 mg/day, a new flare occurred. Liver biopsy was performed and it favoured autoimmune hepatitis diagnosis. We discuss the diagnostic options and treatment approach in a patient with autoimmune disease and possible drug-induced liver injury who initially declined liver biopsy.
authors.affiliation: Department of Gastrenterology, Hospital Garcia de Orta, Almada, Portugal. a.rita.b@gmail.com
authors.forename: Rita
authors.initials: R
authors.lastname: Barosa
authors.forename: Lídia Roque
authors.initials: LR
authors.lastname: Ramos
authors.forename: Cristina
authors.initials: C
authors.lastname: Fonseca
authors.forename: João
authors.initials: J
authors.lastname: Freitas
mesh_terms: D000111:Acetylcysteine / Q000627:therapeutic use; D001706:Biopsy; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis* / Q000188:drug therapy; D003937:Diagnosis, Differential; D005260:Female; D019693:Hepatitis, Autoimmune / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D008111:Liver Function Tests; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy*; D008875:Middle Aged
chemical_list: D000111:Acetylcysteine
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