Autoimmune hepatitis showing spontaneous remission and acute exacerbation

ABSTRACTAutoimmune hepatitis (AIH) represents a chronic liver disease with a progressive nature. Cortocosteroid therapy is routinely used to control this pathological condition. Herein, we describe a case of AIH with spontaneous remission and exacerbation. A previously healthy young Japanese woman presented with features of acute hepatitis. The patient was not acutely infected with hepatotrophic viruses and the possibility of drug-induced AIH was also excluded. A diagnosis of AIH was made from subjective symptoms and laboratory data, which showed increased levels of liver enzymes, total bilirubin, IgG and positive titers of antinuclear antibody. Finally, liver biopsy revealed an expansion of portal tracts and infiltration of mononuclear cells, including plasma cells. This patient experienced a total of three episodes of acute exacerbation of AIH during the past 5 years, two of which subsided spontaneously. An immunosuppressive drug was used to control the last episode of acute exacerbation of AIH, which was very similar to acute hepatitis. The immunosuppressive drug was withdrawn 7 months after the last epoisode of acute exacerbation of AIH and the patient is now passing an uneventful course. There are cases of spontaneous remission and acute exacerbation of AIH, although the underlying mechanism of this pathological process is yet to be determined. Liver biopsy is needed to diagnose these cases. Periodic follow up of these patients is required for proper management