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Case Reports
. 2017 Aug 15;56(16):2139-2143.
doi: 10.2169/internalmedicine.8417-16. Epub 2017 Aug 1.

Histological Changes in Autoimmune Hepatitis with Graves' Disease: A Child Case Report

Mamiko Yamada  1   2 , Hironori Shibata  1 , Yohei Masugi  1 , Tomohiro Ishi  1 , Kaori Kameyama  3 , Hirotoshi Ebinuma  4 , Tomonobu Hasegawa  1
Affiliations
Case Reports

Histological Changes in Autoimmune Hepatitis with Graves' Disease: A Child Case Report

Mamiko Yamada et al. Intern Med. .

Abstract

We herein report a child case of autoimmune hepatitis (AIH) accompanied with Graves' disease. Elevated aminotransferase levels were found in a 12-year-old Japanese girl with Graves' disease. In her first liver biopsy, necrosis and inflammation was limited to the centrilobular area, while the second biopsy showed different findings. Namely, portal injury newly appeared, including interface hepatitis, which represents the histological characteristics of AIH. As the histological findings at the onset of AIH do not always show typical findings, a re-biopsy is considered to be important in individuals suspected to have AIH. AIH should be included in the differential diagnosis of liver dysfunction in Graves' disease, even in children.

Keywords: Graves' disease; autoimmune hepatitis; interface hepatitis; liver histology; pediatric case.

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Figures

Figure 1.
Figure 1.
The histological findings of liver biopsies. A and B were on the first biopsy, C and D were on the second biopsy. (A) Inflammatry cells were scarcely seen at the portal or periportal area at the first biopsy. (B) Moderate necroinflammatory reaction with infiltration of lymphocytes, plasma cells and eosinophils was seen at the centilobular area at the first biopsy. (C) An evident necroinflammatory reaction with lymphoplasmacytic infiltration was seen at the portal and periportal area. Compared with the first biopsy, the marked portal inflammation was revealed. (D) Mild to moderate necroinflammatory reaction was also seen at the centliobular area at the second biopsy.
Figure 2.
Figure 2.
Clinical course of the patient. MMI: methimazole, PSL: prednisone, AZP: azathioprine
See this image and copyright information in PMC

References

    1. Mieli-Vergani G, Vergani D. Autoimmune hepatitis. Nat Rev Gastroenterol Hepatol 8: 320-329, 2011. - PubMed
    1. Gregorio GV, Portmann B, Reid F, et al. . Autoimmune hepatitis in childhood: a 20-year experience. Hepatology 25: 541-547, 1997. - PubMed
    1. Inoue K, Okajima T, Tanaka E, et al. . A case of Graves' disease associated hepatitis and mixed connective tissue disease. Endocr J 46: 173-177, 1999. - PubMed
    1. Onji M, Zeniya M, Yamamoto K, Tsubouchi H. Autoimmune hepatitis: diagnosis and treatment guide in Japan, 2013. Hepatol Res 44: 368-370, 2014. - PubMed
    1. Takikawa H, Onji M. A proposal of the diagnostic scale of drug-induced liver injury. Hepatol Res 32: 250-251, 2005. - PubMed

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