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Acute, chronic autoimmune hepatitis present no significant clinical differences

Immunoserological differences were indistinguishable between patients with acute autoimmune hepatitis and patients with chronic autoimmune hepatitis, according to the results of a recently published study.

“The existence of a genuine acute form of [autoimmune hepatitis] characterized by the presence of massive central necrosis, no or mild inflammatory infiltration in the portal area, and no portal fibrosis could not be denied,” the researchers wrote. “However, given the similarities in the clinicolaboratory features and common histological findings such as interface hepatitis and plasma cell infiltrations between the two groups, most cases of [acute autoimmune hepatitis (AIH-a)] might be attributed to an exacerbation of pre-existing subclinical [chronic autoimmune hepatitis (C-AIH)].”

Between January 2008 and January 2016, the researchers analyzed the immunoserology and histology of 16 patients with acute autoimmune hepatitis and 16 patients with chronic autoimmune hepatitis.

The researchers found no significant differences between the two groups in age, BMI, total bilirubin levels, aspartate aminotransferase, serum alkaline phosphatase, albumin, prothrombin activity or immunoglobulin G. Additionally, there were no significant differences between the groups in antinuclear antibodies titers and both groups had an average International Autoimmune Hepatitis Group based score of 16.1.

All 32 patients showed at least mild portal inflammation. One patient with confirmed acute autoimmune hepatitis showed massive lobular necrosis and another patient experienced a typical sudden onset case with severe liver dysfunction showing acute exacerbation of chronic autoimmune hepatitis detected histologically.

Outstanding differences included a higher degree of activity, lobular inflammation, rosette formation, spotty necrosis, seroid-laden macrophages and single cell necrosis in the patients with acute autoimmune hepatitis compared with a higher degree of severe fibrosis in the patients with chronic autoimmune hepatitis.

“Lobular hepatitis and centrilobular necrosis, including submassive and massive necrosis, were characteristically within the histological spectrum, especially in [autoimmune hepatitis] patients with acute presentation. Centrilobular necrosis might reflect an early lesion in acute [autoimmune hepatitis] preceding portal involvement,” the researchers wrote. “However, nowadays, the concept of [acute autoimmune hepatitis] is assumed to include patients with chronic [autoimmune hepatitis] that has exacerbated spontaneously. The common feature of all acute presentations is the presence of liver inflammation manifested by marked serum ALT elevation and histological changes. The features of centrilobular necrosis without portal inflammation typify acute onset disease.” – by Talitha Bennett

Disclosures: Healio.com/Hepatology was unable to determine the researchers’ relevant financial disclosures at the time of publication.