de-novo autoimmune hepatitis with consecutive acute liver failure induced by hepatitis e infection: a case report

A 49-year-old male patient was referred to our institution for acute liver failure (alv). apart from cholestasis, coagulopathy, andhepatic encephalopathy (he) i°, laboratory studies revealed a significant increase in liver enzymes with an alanine aminotransferase(alt) level of 4’108 u/l and an aspartate aminotransferase (ast) level of 3’878 u/l (normal < 50 u/l), a constellation essentiallycompatible with autoimmune hepatitis (aih). work-up of serological markers for hepatitis e (hev-igm and pcr) was at the sametime positive. furthermore, the patient was strongly positive for antinuclear autoantibodies (ana) with a titer of 1:1’280 (normalupper limit 1:80), and also presented hypergammaglobulinemia (immunoglobulin igg-level of 21.3 g/l; normal 7, 0 - 16, 0 g/l). liverhistology demonstrated massive hepatitis and necrosis with the presence of plasma cells. due to the diagnosis of de-novo autoimmunehepatitis, therapy with steroids was performed despite the evidence of acute hev-infection. it was of great importance thatthe patient recovered completely while neither antiviral therapy with ribavirin nor liver transplantation (lt) was necessary in thefurther course.