THE NATURE AND PROGNOSIS OF SEVERE CRYPTOGENIC CHRONIC ACTIVE HEPATITIS.

Czaja AJ; Carpenter HA; Santrach PJ; Moore SB; Homburger HA; Division of Gastroenterology and Internal Medicine, Mayo Clinic, Rochester, Minnesota. Gastroenterology, 1993 Jun, 104:6, 1755-61

BACKGROUND: Cryptogenic chronic active hepatitis may be an autoimmune or viral disease. Our aims were to determine the clinical features, human leukocyte antigen phenotype, and response to corticosteroid therapy of severe cryptogenic chronic active hepatitis and to compare it with these other diseases. METHODS: Twelve patients with cryptogenic hepatitis were compared with 94 patients with autoimmune hepatitis and 30 patients with chronic viral hepatitis. RESULTS: Patients with cryptogenic hepatitis were indistinguishable from those with autoimmune hepatitis by age, gender, and individual laboratory and histological findings. HLA B8 (75% vs. 49%, P = 0.2), DR3 (71% vs. 51%, P = 0.5), and A1-B8-DR3 (57% vs. 38%, P = 0.6) occurred as commonly in each group. Patients with cryptogenic hepatitis entered remission (83% vs. 78%, P > 0.9) and failed treatment (9% vs. 11%, P > 0.8) as frequently as those with autoimmune hepatitis during corticosteroid therapy. In contrast, patients with chronic viral hepatitis had lower biochemical abnormalities, less frequent multilobular necrosis at presentation, and different human leukocyte phenotypes than those with cryptogenic or autoimmune disease. CONCLUSIONS: Severe cryptogenic hepatitis has a clinical expression, genetic phenotype, and corticosteroid responsiveness that is similar to autoimmune hepatitis. It may be an autoimmune disorder that has escaped detection by conventional immunoserological markers.

IDIOPATHIC CHRONIC ACTIVE HEPATITIS: A DIAGNOSTIC AND THERAPEUTIC DILEMMA.

Al-Fadda M; Zafar M; Ayub A; al-Kahtani K; Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. J Clin Gastroenterol, 1994 Dec, 19:4, 313-7

A 56-year-old Saudi male was admitted with abnormal liver chemistry values and a > 5-month history of lethargy, malaise, anorexia, and jaundice. Extensive investigations did not establish an etiological diagnosis. Liver histology confirmed the clinically apparent aggressive hepatitis with fibrosis but gave no clue to its etiology. The patient was empirically treated with alpha-interferon for presumed non-A, non-B hepatitis, with clinical and biochemical worsening. Interferon was discontinued and the patient was started on immunosuppression. Dramatic clinical and biochemical improvement occurred, with normalization of the liver chemistry within 4 weeks. The patient has been followed-up for 12 months and has not suffered a relapse. This case highlights the etiological heterogeneity of chronic active hepatitis. The entity of autoimmune chronic active hepatitis is unclear, and perhaps it is better defined as steroid-responsive hepatitis. Steroid-responsive hepatitis should always be considered in cases of cryptogenic chronic active hepatitis.

PERSONAL EXPERIENCE IN THE TREATMENT OF CHRONIC VIRAL HEPATITIS B WITH RECOMBINANT INTERFERON B ALFA-2

Nozic D; Mijuskovic P; Bojic I; Marinkovic V; Dimitrijevic J; Milosevic N; Kuljik-Kapulica N; Dokic M; Dordevic; Vojnomedicinska akademija, Klinika za infektivne i tropske bolesti, Beograd, Yugoslavia; Vojnosanit Pregl, 1994 Jul-Aug, 51:4, 281-6

Twelve patients were treated with alpha-2 recombinant interferon during 4 months. Patients were given daily dose of 3 million units three times a week. Therapeutic effect expressed as the percentage of HBeAG seroconversion or by the loss of antibodies for the core antigen in IgM fraction and by the core antigen loss from hepatic tissue, was achieved in 41.6% of patients. Corticosteroids, administered before interferon, could improve therapeutic effect. Better response to therapy was observed in patients with higher serum transaminase levels and with histopathologically confirmed chronic hepatitis. Predictive value of each immunological parameter of therapeutic effect requires further study.

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