Clinical

Chickenpox tied to autoimmune hepatitis

Last Updated: 2009-03-18 18:05:02 -0400 (Reuters Health)

NEW YORK (Reuters Health) - A case report from Saudi Arabia in which a patient with varicella zoster infection went on to develop severe autoimmune hepatitis helps sheds more light on this poorly understood condition.

"This report," investigator Dr. Waleed K. Al-Hamoudi told Reuters Health, "supports previously published cases implicating the role of different viruses in the pathogenesis of autoimmune hepatitis. Such findings should alert physicians to consider autoimmune hepatitis in any patient with deranged liver enzymes following viral infections."

The patient, a 23-year old man, was referred to Dr. Al-Hamoudi and colleagues at King Saud University in Riyadh after having experienced jaundice, anorexia, weight loss and malaise for 2 months. This followed an episode of varicella zoster infection which he had acquired from family members.

The findings are published in the February 28th issue of the World Journal of Gastroenterology.

Laboratory findings were indicative of autoimmune hepatitis, and the patient showed the presence of anti-varicella zoster virus IgC antibodies. There were negative findings for others including anti-Epstein-Barr virus IgM.

At this point, the man refused a liver biopsy, but prednisone treatment, starting at 60 mg and tapering, prompted a dramatic response. Within 2 months his liver enzymes normalized. However, reduction in his steroid dose caused further derangement and the dose was increased.

About 9 months later, he was feeling well, his liver enzymes were normal and all medication was stopped. Nevertheless, follow-up revealed an increase in his liver enzymes and a liver biopsy revealed features of autoimmune hepatitis including interface hepatitis and bridging fibrosis. Treatment was re-instated and he went on to show improvement.

Physicians should be aware of this condition, concluded Dr. Al-Hamoudi, "as autoimmune hepatitis can lead to liver cirrhosis in a relatively short period -- months -- if not identified and treated promptly."

World J Gastroenterol 2009;15:1004-1006.