title: Fulminant type 1 autoimmune hepatitis in a recently diagnosed celiac disease patient.
abstract: Celiac disease (CD) is a small intestine immune-mediated disorder triggered by gluten ingestion in genetically predisposed patients. This condition can also affect many extraintestinal tissues, including the liver. We report a patient presenting with a marked increase of transaminases at diagnosis of CD. The immune markers for autoimmune hepatitis (AIH) were negative. Following a few months of a strict gluten-free diet (GFD), aminotransferase levels decreased significantly (< 2.5x U/L). The response to GFD suggested that the liver damage was due to a gluten-dependent celiac hepatitis, the most common liver abnormality in CD. Despite the fact that the patient never stopped the GFD, yet, in a few months, the aminotransferase levels raise again to high values (> 50x U/L). At this time, the liver autoantibodies turned to be positive thus confirming the development of a type 1 AIH. The hepatic damage progressed to a late onset liver failure requiring liver transplantation.
authors.affiliation: Department of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. umberto.volta@aosp.bo.it.
authors.forename: Umberto
authors.initials: U
authors.lastname: Volta
authors.forename: Kamran
authors.initials: K
authors.lastname: Rostami
authors.forename: Francesco
authors.initials: F
authors.lastname: Tovoli
authors.forename: Giacomo
authors.initials: G
authors.lastname: Caio
authors.forename: Chiara
authors.initials: C
authors.lastname: Masi
authors.forename: Eugenio
authors.initials: E
authors.lastname: Ruggeri
authors.forename: Giulia
authors.initials: G
authors.lastname: Cacciari
authors.forename: Isabella
authors.initials: I
authors.lastname: Bon
authors.forename: Roberto
authors.initials: R
authors.lastname: De Giorgio
mesh_terms: D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D002446:Celiac Disease / Q000150:complications* / Q000178:diet therapy; D055050:Diet, Gluten-Free; D018450:Disease Progression; D005260:Female; D019693:Hepatitis, Autoimmune / Q000097:blood* / Q000150:complications* / Q000628:therapy; D006801:Humans; D016031:Liver Transplantation; D008875:Middle Aged
chemical_list: D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase