Prolonged acute hepatitis A mimicking autoimmune hepatitis

Table 1 Laboratory data on admission.

Peripheral blood		Blood chemistry		Serology
WBC	4 600 /L	T.Bili	0.8 mg/dL	IgG	2040 mg/dL
RBC	438 x 10‚S/L	GOT	398 IU/L	IgA	274 mg/dL
Hb	13.6 g/dL	GPT	1143 IU/L	IgM	158 mg/dL
Ht	39.5%	LDH	283 IU/L	CRP	0.1 mg/dL
MCV	90.0 fl	ALP	317 IU/L	Immunology
MCH	31.0 pg	-GTP	349 IU/L	ANA	× 160
MCHC	34.4%	T-CHO	170 mg/dL	ASMA	× 40
Plt	27.8 x 104 /L	TG	73 mg/dL	AMA	(-)
Coagulation		Glu	95 mg/dL	anti-LKM-1 Ab	(-)
PT	12.7 s (96%)	BUN	15 mg/dL	HLA-DR6, DR9
APTT	32.2 s	Cr	0.54 mg/dL	Viral markers
	TP	8.0 mg/dL	IgM HA-Ab	1.1
ESR	4 mm/1h	Alb	4.5 g/dL	HAV-RNA	(-)
	14 mm/2h	TSH	0.95 IU/mL	HBs-Ag	(-)
		FreeT3	3.04 pg/mL	HCV-Ab	(-)
		FreeT4	1.16 ng/mL	HCV-RNA	(-)

Abbreviations: ANA, anti-nuclear antibodies; ASMA, anti-smooth muscle antibodies; AMA, anti-mitochondrial antibody; anti-LKM-1 Ab, anti-liver kidney microsome-1 antibody; HLA, human lymphocyte antigens.

Table 2 Reports of AIH triggered by HAV infection.

	Age	Sex	Interval (wk)	IgG (mg/dL)	Therapy
Vent S, et al (1991)	13	F	17	N.D.	Steroid
Vent S, et al (1991)	18	M	19	N.D.	Steroid
Rahaman SM, et al (1992)	55	F	10	2070	Steroid
Huppertz HI, et al (1993)	7	M	10	3700	Steroid
Oshikata S, et al (1996)	70	M	28	2313	Steroid
Hilzenrat N, et al (1999)	55	F	N.D.	N.D.	Steroid
Tamura T, et al (2000)	39	F	8	2219	Steroid
Present case	48	F	16	2040	UDCA

N.D.: not described. Interval: from hepatitis A infection to onset of AIH (wk).