High-Titre ANA Positivity in NAFLD: An Uncommon Presentation of a Common Disease

Abstract

Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease and has emerged as a serious public health challenge. About 20% of NAFLD patients may have low titres (<1:320) of antinuclear antibodies (ANA). However, we describe a patient with NAFLD whose ANA titre was high (>1:320) on presentation. After 3 months of diet, exercise and vitamin E supplementation, the patient was symptomatically better but her ANA titre had increased (>1:640). Her liver biopsy showed features of NAFLD with minimal fibrosis. High-titre ANA (>1:320) positivity is rare. Our patient showed a progressive rise in ANA titre from >1:320 to >1:640 within 3 months even though she was improving and histology showed minimal fibrosis.

Learning points: Up to 30% of patients with non-alcoholic fatty liver disease (NAFLD) may have antinuclear antibodies (ANA).Low titre (<1:320) ANA positivity is not uncommon, but a high titre is rare.The ANA titre does not correlate with the histological grade of NAFLD.

Keywords: Antinuclear antibody; autoimmune hepatitis; liver biopsy; non-alcoholic fatty liver disease.

Figure 1

Microscopic view of liver tissue (hematoxylin-eosin, x400) showing fat infiltration of 30–40% of hepatocytes, minimal lobular inflammation and no ballooning cells (NAFLD activity score 2) consistent with steatosis and interface hepatitis. Minimal pericellular and periportal fibrosis (Fibrosis score 2) Courtesy to Dr Sourav Bhowmik, Department of Pathology, Ruby General Hospital, Kolkata, India