title: Clinicopathological profile and management of severe autoimmune hepatitis.
abstract: BACKGROUND
  Severe autoimmune hepatitis is an entity which has been rarely reported in the Indian literature. We describe here the clinicopathological profile and treatment of severe autoimmune hepatitis (SAH) which is to the best of our knowledge the first report from India addressing this illness.
  
  
  RESULTS
  Between September 2010 and March 2013, 13 patients seeking treatment at our centre were diagnosed as SAH and treated with steroids. Jaundice along with coagulopathy was the presenting symptom in all these patients. Ascites was present in ten and encephalopathy in 6 patients. The median serum IgG was 2135 mg/dl (range: 1122-5490).Significant titers of autoantibodies were present in all patients except one. Transjugular liver biopsy in 9 patients showed characteristic features of SAH such as extensive bridging necrosis and moderate to dense portal inflammation. With corticosteroid therapy, 10 patients survived while three died. In those who survived, biochemical improvement was seen as early as seven days with excellent long-term remission.
  
  
  CONCLUSIONS
  Clinical suspicion supported by liver biopsy and autoimmune serology led to the diagnosis of SAH in a cohort of patients with unexplained liver failure. Corticosteroids were beneficial in majority of patients affording excellent results and this could be predicted by early reduction in serum bilirubin within 7-15 days.
authors.forename: Jeyamani
authors.initials: J
authors.lastname: Ramachandran
authors.forename: K G
authors.initials: KG
authors.lastname: Sajith
authors.forename: Sandip
authors.initials: S
authors.lastname: Pal
authors.forename: Jiffy V A
authors.initials: JV
authors.lastname: Rasak
authors.forename: John Antony Jude
authors.initials: JA
authors.lastname: Prakash
authors.forename: Banumathi
authors.initials: B
authors.lastname: Ramakrishna
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D015331:Cohort Studies; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D019693:Hepatitis, Autoimmune / Q000150:complications / Q000473:pathology* / Q000628:therapy*; D006801:Humans; D007194:India; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000627:therapeutic use; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D005938:Glucocorticoids; D011239:Prednisolone