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Case Reports
. 2020;59(11):1401-1405.
doi: 10.2169/internalmedicine.4092-19. Epub 2020 Jun 1.

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

Hideaki Kawabata  1 , Yukino Kawakatsu  1 , Naonori Inoue  1 , Yuji Okazaki  1 , Daiki Sone  1 , Katsutoshi Yamaguchi  1 , Yuki Ueda  1 , Misuzu Hitomi  1 , Masatoshi Miyata  1 , Shigehiro Motoi  1 , Yasuyuki Enoki  2 , Tetsuhiro Minamikawa  2
Affiliations
Case Reports

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

Hideaki Kawabata et al. Intern Med. 2020.

Abstract

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.

Keywords: IgG4; autoimmune hepatitis; drug-induced.

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Conflict of interest statement

The authors state that they have no Conflict of Interest (COI).

Figures

Figure 1.
Figure 1.
Computed tomography revealed no mass lesions, stones or biliary duct dilatation.
Figure 2.
Figure 2.
a, b: A needle liver biopsy specimen showing interface hepatitis with mainly lymphocytic infiltration and occasional bridging fibrosis in the periportal area, indicating chronic active hepatitis due to AIH (Hematoxylin and Eosin staining, a: ×100, b: ×400). c: Immunohistochemistry showing lymphocytic infiltration lymphocytic infiltration that was positive for IgG4 (140 cells per high-powered field) with an IgG4/IgG-positive cell ratio of 60%, which suggested the IgG4-related type. AIH: autoimmune hepatitis
Figure 3.
Figure 3.
Clinical course. AST: aspartate aminotransferase, ALT: alanine aminotransferase, γ-GTP: γ-glutamyl transpeptidase, PSL: prednisolone, UDCA: ursodeoxycholic acid
See this image and copyright information in PMC

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