Eosinophilia in autoimmune hepatitis: is there an association?

Background: There were several reports on eosinophilic drug-induced hepatitis. We report a case of autoimmune hepatitis (AIH) presenting with eosinophilia in whom steroid therapy induces resolution of both eosnophilia and hepatitis. CASE REPORT: A 57 years old lady who presented with jaundice and r...

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Main Authors:	Mustafa, Ahmad Suhaimi, Tee, Hoi Poh, Che Aun, Azlida, Jaafar, Khairul Azhar, Satwi, Sapari
Format:	Article
Language:	English
Published:	Malaysian Medical Associations 2011
Subjects:	RC Internal medicine
Online Access:	http://irep.iium.edu.my/23667/ http://irep.iium.edu.my/23667/ http://irep.iium.edu.my/23667/1/eosinophilia_in_autoimmune_hepatitis_is_there_an_assocation.pdf

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spelling	iium-236672012-04-24T06:49:07Z http://irep.iium.edu.my/23667/ Eosinophilia in autoimmune hepatitis: is there an association? Mustafa, Ahmad Suhaimi Tee, Hoi Poh Che Aun, Azlida Jaafar, Khairul Azhar Satwi, Sapari RC Internal medicine Background: There were several reports on eosinophilic drug-induced hepatitis. We report a case of autoimmune hepatitis (AIH) presenting with eosinophilia in whom steroid therapy induces resolution of both eosnophilia and hepatitis. CASE REPORT: A 57 years old lady who presented with jaundice and right hypochondriac pain associated with tender hepatomegaly and urticarial rash. Blood investigations showed high eosinophil counts persistently ranging from 800 to 1500/mm3 with highly elevated bilirubin of 380 umol/L, alanine transaminase 750 U/L and aspartate transaminase of 1015 U/L. She has raised serum immunoglobulin IgG of 21.6 g/L. Liver biopsy showed moderate interface hepatitis and plasma cells infiltration suggesting AIH. However, her antinuclear antibody was negative. She had negative serology for hepatitis A, B and C and a normal ultrasound abdomen. Definite diagnosis of AIH was made based on Codified Dignostic Criteria of the International Autoimmune Hepatitis Group with aggregate score 17. On starting steroid, she had a complete normalization of liver function and eosinophil production induced by compounds released by basophills and mast cells, including eosinophill chemotactic facotr of anaphylaxis, leukotriene B4, complement complex (C5-C6-C7), interleukin 5, and histamine. AIH is characterized by an inflammation of the portal tract with lymphocytes and plasma cells, hypergammaglobulinemia and presence of a variety of circulatin autoantibodies. While eosionophilia is humoral (antibody-mediated), AIH is characterized by an inflammation of the portal tract with lymphocytes and plasma cells, hypergammaglobulinemia and presence of a varety iof circulatin autoantibodies. While eosionophillia is humoral (antibody-mediated), AIH is thought to be cell-mediated. Presence of both conditions in an individual is uncommon. In this case effort had been maed to rule out other cases of eosinophilia such as drug-induced or helminthic infections but there were all negative. The mechanism of dual-pathology in this case remains unresolved. CONCLUSION: Eosinophilia is not a diagnostic feature for AIH.An association wtih AIH is suggested in this case. Malaysian Medical Associations 2011-07 Article PeerReviewed application/pdf en http://irep.iium.edu.my/23667/1/eosinophilia_in_autoimmune_hepatitis_is_there_an_assocation.pdf Mustafa, Ahmad Suhaimi and Tee, Hoi Poh and Che Aun, Azlida and Jaafar, Khairul Azhar and Satwi, Sapari (2011) Eosinophilia in autoimmune hepatitis: is there an association? Medical Journal of Malaysia, 66 (Supp A). p. 10. ISSN 0300-5283 http://www.e-mjm.org/2011/Sup_A_liver_update.pdf
repository_type	Digital Repository
institution_category	Local University
institution	International Islamic University Malaysia
building	IIUM Repository
collection	Online Access
language	English
topic	RC Internal medicine
spellingShingle	RC Internal medicine Mustafa, Ahmad Suhaimi Tee, Hoi Poh Che Aun, Azlida Jaafar, Khairul Azhar Satwi, Sapari Eosinophilia in autoimmune hepatitis: is there an association?
description	Background: There were several reports on eosinophilic drug-induced hepatitis. We report a case of autoimmune hepatitis (AIH) presenting with eosinophilia in whom steroid therapy induces resolution of both eosnophilia and hepatitis. CASE REPORT: A 57 years old lady who presented with jaundice and right hypochondriac pain associated with tender hepatomegaly and urticarial rash. Blood investigations showed high eosinophil counts persistently ranging from 800 to 1500/mm3 with highly elevated bilirubin of 380 umol/L, alanine transaminase 750 U/L and aspartate transaminase of 1015 U/L. She has raised serum immunoglobulin IgG of 21.6 g/L. Liver biopsy showed moderate interface hepatitis and plasma cells infiltration suggesting AIH. However, her antinuclear antibody was negative. She had negative serology for hepatitis A, B and C and a normal ultrasound abdomen. Definite diagnosis of AIH was made based on Codified Dignostic Criteria of the International Autoimmune Hepatitis Group with aggregate score 17. On starting steroid, she had a complete normalization of liver function and eosinophil production induced by compounds released by basophills and mast cells, including eosinophill chemotactic facotr of anaphylaxis, leukotriene B4, complement complex (C5-C6-C7), interleukin 5, and histamine. AIH is characterized by an inflammation of the portal tract with lymphocytes and plasma cells, hypergammaglobulinemia and presence of a variety of circulatin autoantibodies. While eosionophilia is humoral (antibody-mediated), AIH is characterized by an inflammation of the portal tract with lymphocytes and plasma cells, hypergammaglobulinemia and presence of a varety iof circulatin autoantibodies. While eosionophillia is humoral (antibody-mediated), AIH is thought to be cell-mediated. Presence of both conditions in an individual is uncommon. In this case effort had been maed to rule out other cases of eosinophilia such as drug-induced or helminthic infections but there were all negative. The mechanism of dual-pathology in this case remains unresolved. CONCLUSION: Eosinophilia is not a diagnostic feature for AIH.An association wtih AIH is suggested in this case.
format	Article
author	Mustafa, Ahmad Suhaimi Tee, Hoi Poh Che Aun, Azlida Jaafar, Khairul Azhar Satwi, Sapari
author_facet	Mustafa, Ahmad Suhaimi Tee, Hoi Poh Che Aun, Azlida Jaafar, Khairul Azhar Satwi, Sapari
author_sort	Mustafa, Ahmad Suhaimi
title	Eosinophilia in autoimmune hepatitis: is there an association?
title_short	Eosinophilia in autoimmune hepatitis: is there an association?
title_full	Eosinophilia in autoimmune hepatitis: is there an association?
title_fullStr	Eosinophilia in autoimmune hepatitis: is there an association?
title_full_unstemmed	Eosinophilia in autoimmune hepatitis: is there an association?
title_sort	eosinophilia in autoimmune hepatitis: is there an association?
publisher	Malaysian Medical Associations
publishDate	2011
url	http://irep.iium.edu.my/23667/ http://irep.iium.edu.my/23667/ http://irep.iium.edu.my/23667/1/eosinophilia_in_autoimmune_hepatitis_is_there_an_assocation.pdf
first_indexed	2023-09-18T20:35:46Z
last_indexed	2023-09-18T20:35:46Z
_version_	1777409035220287488

Eosinophilia in autoimmune hepatitis: is there an association?

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