title: Clinical and laboratory features and natural history of seronegative hepatitis in a nontransplant centre.
abstract: BACKGROUND
  Seronegative hepatitis is a recognized cause of liver failure requiring transplantation. The aetiology is unknown, but might relate to an unidentified virus or immune dysregulation. There are few data on seronegative hepatitis presenting to nontransplant centres.
  
  
  OBJECTIVE
  To describe the clinical/laboratory features and natural history of seronegative hepatitis and compare these with viral/autoimmune hepatitis.
  
  
  METHODS
  Cases of seronegative, viral and autoimmune hepatitis were identified from 2080 consecutive patients attending a rapid-access jaundice clinic over a 14-year period.
  
  
  RESULTS
  Of 881 patients with hepatocellular jaundice, 27 (3%) had seronegative hepatitis, 44 (5%) autoimmune and 62 (7%) viral hepatitis (acute hepatitis A, B, C and E viruses). Fifteen out of 27 (56%) patients with seronegative hepatitis were male, median age 60 years (range 14-74). Peak bilirubin was 63 μmol/l (range 9-363), alanine aminotransferase 932 IU/l (range 503-3807). Duration of illness was 7 weeks (range 4-12). No patients developed liver failure or had further bouts of hepatitis. One patient developed acute lymphoblastic leukaemia shortly after presentation.There was no difference in age/sex of patients with seronegative hepatitis and those with viral hepatitis. Compared with autoimmune hepatitis (age 65 years, range 15-91), patients with seronegative hepatitis were younger (P=0.002) and more likely to be male (P=0.004). Patients with autoimmune hepatitis were more likely (P<0.0001) to have an albumin less than 35 g/l, international normalized ratio greater than 1.2, raised IgG and positive antinuclear/smooth muscle antibody, compared with patients with seronegative hepatitis.
  
  
  CONCLUSIONS
  Seronegative hepatitis presenting to a nontransplant centre is generally a self-limiting illness. The aetiology is more likely to be viral than autoimmune.
authors: Cornwall Gastrointestinal Unit, Royal Cornwall Hospital, UK.
authors: Laura
authors: L
authors: Donaghy
authors: Fergus J
authors: FJ
authors: Barry
authors: Jeremy G
authors: JG
authors: Hunter
authors: William
authors: W
authors: Stableforth
authors: Iain A
authors: IA
authors: Murray
authors: Jo
authors: J
authors: Palmer
authors: Richard P
authors: RP
authors: Bendall
authors: Ahmed M
authors: AM
authors: Elsharkawy
authors: Harry R
authors: HR
authors: Dalton
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000410:Alanine Transaminase / Q000097:blood; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000097:blood; D006505:Hepatitis / Q000097:blood / Q000150:complications / Q000276:immunology*; D019693:Hepatitis, Autoimmune / Q000097:blood / Q000150:complications / Q000276:immunology; D006525:Hepatitis, Viral, Human / Q000097:blood / Q000150:complications / Q000276:immunology; D006801:Humans; D007565:Jaundice / Q000209:etiology; D008875:Middle Aged; D055815:Young Adult
chemical_list: D015415:Biomarkers; D000410:Alanine Transaminase; D001663:Bilirubin