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Chronic Hepatitis with Combined Features of Autoimmune Chronic Hepatitis and Chronic Hepatitis C: Favorable Response to Prednisone and Azathioprine

Somashekhar Bellary, MD; Thomas Schiano, MD; Grace Hartman, MD; and Martin Black, MD
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From Temple University Hospital, Philadelphia, Pennsylvania. Requests for Reprints: Martin Black, MD, Liver Unit, Department of Gastroenterology, 8th Floor, Parkinson Pavilion, Temple University Hospital, 3401 North Broad Street, Philadelphia, PA 19140. Acknowledgment: The authors thank Lynne Rivers for secretarial assistance. Grant Support: By a grant from Shering-Plough Corporation.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1995;123(1):32-34. doi:10.7326/0003-4819-123-1-199507010-00004
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The evidence for an association between autoimmune forms of chronic hepatitis and hepatitis C virus (HCV) infection is controversial [13]. Although anti-liver-kidney microsomal antibody-positive autoimmune chronic hepatitis appears to be associated with HCV infection [4], evidence of such an association is less convincing with other subtypes of autoimmune chronic hepatitis [5]. Autoantibodies are frequently found in patients with chronic hepatitis C, although usually in low titers [68], which suggests that HCV elicits an immune response in the host. In a small subset of patients with chronic hepatitis C, autoantibodies are seen in high titers along with hypergammaglobulinemia, which further clouds the distinction between autoimmune chronic hepatitis and chronic hepatitis C. This has important therapeutic implications because inappropriate treatment of autoimmune chronic hepatitis with interferon-α may exacerbate liver disease [910]. Conversely, corticosteroid therapy for chronic hepatitis C may enhance HCV replication [1112], which could worsen underlying liver disease. Few data are available to show how patients with features of both autoimmune hepatitis and chronic hepatitis C should be treated.

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Grahic Jump Location
Figure 1.

Pretreatment liver biopsy specimen in patient 1 showing portal and periportal inflammation with piecemeal necrosis. Liver biopsy specimen after treatment in the same patient showing an intact limiting plate with minimal portal inflammation.

Grahic Jump Location




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