IgG4-related Autoimmune Hepatitis with a Suspected Drug-induced Etiology

A 69-year-old man was referred to our department with acute hepatitis. He had been newly treated with benidipine hydrochloride for two months. His blood test results were as follows: aspartate aminotransferase, 1,614 IU/L; alanine aminotransferase, 1,091 IU/L and anti-smooth muscle antibody, ×80. Ne...

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Bibliographic Details
Published in:Internal Medicine 2020/06/01, Vol.59(11), pp.1401-1405
Main Authors: Kawabata, Hideaki, Kawakatsu, Yukino, Inoue, Naonori, Okazaki, Yuji, Sone, Daiki, Yamaguchi, Katsutoshi, Ueda, Yuki, Hitomi, Misuzu, Miyata, Masatoshi, Motoi, Shigehiro, Enoki, Yasuyuki, Minamikawa, Tetsuhiro
Format: Article
Language:English
Subjects:
Alanine
Alanine transaminase
Aspartate aminotransferase
autoimmune hepatitis
Biopsy
Case Report
drug-induced
Etiology
Fibrosis
Hepatitis
IgG4
Immunoglobulin G
Immunohistochemistry
Infiltration
Internal medicine
Prednisolone
Remission
Smooth muscle
Steroid hormones
Ursodeoxycholic acid
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Summary:A 69-year-old man was referred to our department with acute hepatitis. He had been newly treated with benidipine hydrochloride for two months. His blood test results were as follows: aspartate aminotransferase, 1,614 IU/L; alanine aminotransferase, 1,091 IU/L and anti-smooth muscle antibody, ×80. Needle liver biopsy specimen showed interface hepatitis with mainly lymphocytic infiltration and bridging fibrosis in the periportal area. Immunohistochemistry revealed lymphocytic infiltration positive for IgG4. We diagnosed him with IgG4-related AIH with an etiology that was suspected of being drug-induced. Oral prednisolone was started and then tapered after achieving biochemical remission. Hepatitis recurred after the cessation of steroids; however, remission was achieved with ursodeoxycholic acid.
ISSN:0918-2918
1349-7235
DOI:10.2169/internalmedicine.4092-19