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Case Reports in Gastrointestinal Medicine
Volume 2018 (2018), Article ID 2139607, 3 pages
https://doi.org/10.1155/2018/2139607
Case Report

A Case of Acute Autoimmune Hepatitis Superimposed on Chronic Hepatitis B Infection

1Department of Internal Medicine, St. Joseph’s University Medical Center, Paterson, NJ, USA
2Department of Gastroenterology and Hepatology, St. Joseph’s University Medical Center, Paterson, NJ, USA

Correspondence should be addressed to Hiren G. Patel; moc.liamg@727nerih

Received 2 January 2018; Revised 18 February 2018; Accepted 28 February 2018; Published 1 April 2018

Academic Editor: Olga I. Giouleme

Copyright © 2018 Vanessa Sostre et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Autoimmune hepatitis has been associated with chronic HCV infection, but there are only few cases reported of HBV infection as a possible trigger. We present a case of a young male who was diagnosed with acute autoimmune hepatitis superimposed on existent chronic HBV infection. A 30-year-old Hispanic male with no past medical history presented to the hospital with complaints of few days of generalized weakness. Laboratory findings were significant for elevated liver enzymes: AST, 1164 U/L; ALT, 1461 U/L; total bilirubin, 2 MG/DL; and alkaline phosphatase, 75 IU/L. Extensive workup was done to find the etiology for elevated liver enzymes. Only blood work that came back positive was for chronic HBV infection and elevated immunoglobulin G (IgG) level 1937 mg/dL. HBV viral load was 42,900,000 IU/mL. The patient was started on tenofovir 300 mg daily. Liver biopsy was done which was consistent with autoimmune hepatitis. Prednisone 60 mg daily was started. Six months later, blood work showed completely normal liver enzymes and total IgG. Hepatotropic viruses have been proposed as triggering factors for several autoimmune diseases. There are theories suggesting that similarity in viral epitope and self-proteins expression on liver cells’ surface causes a cross-reactive immunologic response and possible viral-induced autoimmune hepatitis.