Autoimmune hepatitis in pregnancy: case report
DOI:
https://doi.org/10.52556/2587-3873.2023.4(97).22Keywords:
autoimmune hepatitis, antinuclear antibodies, immunosuppressive treatmentAbstract
Autoimmune hepatitis (AIH) is a progressive chronic liver disease of unknown cause, with varied clinical picture and evolution. The diagnosis of autoimmune hepatitis is based on histological changes (interface hepatitis), characteristic clinical and biological signs (hypertransaminasemia and increased serum IgG concentration), with the presence of one or more characteristic autoantibodies. The purpose of this presentation was to analyze the evolution of the disease of a patient with autoimmune hepatitis during pregnancy, the safety of the treatment, and the long-term results/complications of immunosuppressive therapy. During this period, the patient periodically stopped the treatment, had a pregnancy that ended with the intrauterine death of the fetus, and then managed to give birth to a healthy child. Predniso(lo)n as initial therapy, followed by the addition of azathioprine after two weeks, are the first-line treatment for AIH, including in pregnancy. In our patient, immunosuppressive therapy with prednisone and azathioprine was safe and effective in inducing and maintaining remission, without significant complications or exacerbation during the pregnancy. Thus, an early established diagnosis and the prompt application of appropriate treatment, strict monitoring of the disease and of immunosuppressive treatment complications, can improve the evolution of AIH, slowing the progression of the disease.
References
1. Overview of autoimmune hepatitis - UpToDate. [Online]. Available: https://www.uptodate.com/contents/overview-of-autoimmune-hepatitis?search=autoimmunehepatitis&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1.
2. European Association for the Study of Liver. EASL Clinical Practice Guidelines: Autoimmune hepatitis. In: J. Hepatol., 2015, vol. 63, pp. 971-1004. https://doi.org/10.1016/j.jhep.2015.06.030
3. Czaja A. Emerging therapeutic biomarkers of autoim-mune hepatitis and their impact on current and future management. In: Expert Rev Gastroenterol Hepatol. 2018, nr. 12, pp. 547-564. https://doi.org/10.1080/17474124.2018.1453356
4. Mack C. şi al. Diagnosis and Management of Auto-immune Hepatitis in Adults Children: 2019 Practice Guidance and Guidelines From the American Associa-tion for the Study of Liver Diseases. In: Hepatology. 2020, vol. 72, nr. 2, pp. 671-722. https://doi.org/10.1002/hep.31065
5. Fogel R. şi al. Extrahepatic autoimmune diseases are prevalent in autoimmune hepatitis patients and their first-degree relatives: survey study. In: Interact J Med Res. 2018, nr. 7, pp. e18-26. https://doi.org/10.2196/ijmr.9625
6. Balitzer D. şi al. Autoimmune hepatitis: review of histologic features included in the simplified criteria proposed by the international autoimmune hepatitis group and proposal for new histologic criteria. In: Mod Pathol. 2017, nr. 30, pp. 773-783. https://doi.org/10.1038/modpathol.2016.267
7. Dhruv L., Savio J. Autoimmune hepatitis: Appraisal of current treatment guidelines. In: World J Hepatol. 2018, nr. 10(12), pp. 911-923. https://doi.org/10.4254/wjh.v10.i12.911
8. Anand L. şi al. Flare of autoimmune hepatitis causing acute on chronic liver failure: diagnosis and response to corticosteroid therapy. In: Hepatology. 2019, vol. 70, pp. 587-596. https://doi.org/10.1002/hep.30615
9. Wu S. şi al. Systematic review: diagnostic accuracy of non-invasive tests for staging liver fibrosis in au-toimmune hepatitis. In: Hepatol Int. 2019, nr. 13, pp. 91-101. https://doi.org/10.1007/s12072-018-9907-5
10. Pape S. şi al. Systematic review of response criteria and endpoints in autoimmune hepatitis by the Inter-national Autoimmune Hepatitis Group. In: Journal of Hepatology 2022 vol. 76, pp. 841-849.
11. Gadour E. Autoimmune Hepatitis: Treatment Options and Management Review. In: cureus, 2021, 13(6): e15682.
https://doi.org/10.7759/cureus.15682
12. Tran T.T., Ahn J., Reau N.S.. Acg Clinical Guideline: Liver Disease and Pregnancy. In: am J Gastroenterol, 2016;111, pp. 176-194. https://doi.org/10.1038/ajg.2015.430
13. CDC. National birth defects prevention study (NBDPS). 2017:https://www.cdc.gov/ncbddd/birthdefects/nbdps.html.
Downloads
Published
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
