Particularities of Autoimmune Hepatitis in Latin America

Clinical, biochemical and histological features related to treatment response and prognosis in autoimmune hepatitis

INTRODUCTION AND OBJECTIVES

Autoimmune hepatitis (AIH) is a rare disease with a complex and not fully understood pathogenesis. Prognostic factors that might influence treatment response, relapse rates, and transplant-free survival are not well established. This study investigates clinical and biochemical markers associated with response to immunosuppression in patients with AIH.

MATERIALS AND METHODS

This retrospective cohort study included 102 patients with AIH treated with immunosuppressants and followed at the Federal University of Minas Gerais, Brazil, from 1990 to 2018. Pretreatment data such as clinical profiles, laboratory, and histological exams were analyzed regarding biochemical response at one year, histological remission, relapse, and death/transplantation rates.

RESULTS

Cirrhosis was present in 59 % of cases at diagnosis. One-year biochemical remission was observed in 55.7 % of the patients and was found to be a protective factor for liver transplant. Overall survival was 89 %. Patients with ascites at disease onset showed a higher aspartate aminotransferase (AST)/ alanine aminotransferase (ALT) ratio and elevated Model of end-stage liver disease (MELD) score. The presence of ascites was significantly associated with a 20-fold increase in mortality rate.

CONCLUSIONS

AIH has a severe clinical phenotype in Brazilians, with high rates of cirrhosis and low remission rates. Early diagnosis and treatment are essential for achieving remission and reducing complications. The presence of ascites is significantly associated with mortality, emphasizing the importance of monitoring and prompt intervention. This study also stresses the need for further research on AIH in Latin America.

Autoimmune Hepatitis Associated With Cryoglobulinemic Vasculitis

Cryoglobulinemic vasculitis presents liver abnormalities usually associated with hepatitis C. We report a case of a 27-year-old woman with cryoglobulinemia and liver dysfunction secondary to autoimmune hepatitis. The patient developed purpura on the lower extremities and elevated aminotransferases. The investigation of hepatitis C was negative. Autoimmune hepatitis was confirmed by positive ANA, hypergammaglobulinemia, and compatible histological changes. Treatment with prednisone and azathioprine regressed cutaneous vasculitis and decreased aminotransferases. This case describes a rare association of cryoglobulinemic vasculitis and autoimmune hepatitis.