Case Report
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Feb 27, 2024; 16(2): 286-293
Published online Feb 27, 2024. doi: 10.4254/wjh.v16.i2.286
Autoimmune hepatitis and primary sclerosing cholangitis after direct-acting antiviral treatment for hepatitis C virus: A case report
Yoshiki Morihisa, Hobyung Chung, Shuichiro Towatari, Daisuke Yamashita, Tetsuro Inokuma
Yoshiki Morihisa, Hobyung Chung, Shuichiro Towatari, Tetsuro Inokuma, Department of Gastroenterology and Hepatology, Kobe City Medical Center General Hospital, Kobe 650-0047, Hyogo, Japan
Daisuke Yamashita, Department of Pathology, Kobe City Medical Center General Hospital, Kobe 650-0047, Hyogo, Japan
Author contributions: Morihisa Y drafted the manuscript; Chung H, Towatari S, Yamashita D, and Inokuma T contributed to the critical revision of the manuscript; all authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patients for the publication of this report and any accompanying images.
Conflict-of-interest statement: All authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hobyung Chung, MD, PhD, Doctor, Department of Gastroenterology and Hepatology, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminami-machi, Chuo-ku, Kobe 650-0047, Hyogo, Japan. teihiroshi@gmail.com
Received: November 30, 2023
Peer-review started: November 30, 2023
First decision: December 8, 2023
Revised: December 22, 2023
Accepted: January 16, 2024
Article in press: January 16, 2024
Published online: February 27, 2024
Processing time: 88 Days and 21.3 Hours
Abstract
BACKGROUND

Chronic hepatitis C virus (HCV) infection is a major global health concern that leads to liver fibrosis, cirrhosis, and cancer. Regimens containing direct-acting antivirals (DAAs) have become the mainstay of HCV treatment, achieving a high sustained virological response (SVR) with minimal adverse events.

CASE SUMMARY

A 74-year-old woman with chronic HCV infection was treated with the DAAs ledipasvir, and sofosbuvir for 12 wk and achieved SVR. Twenty-four weeks after treatment completion, the liver enzyme and serum IgG levels increased, and antinuclear antibody became positive without HCV viremia, suggesting the development of autoimmune hepatitis (AIH). After liver biopsy indicated AIH, a definite AIH diagnosis was made and prednisolone was initiated. The treatment was effective, and the liver enzyme and serum IgG levels normalized. However, multiple strictures of the intrahepatic and extrahepatic bile ducts with dilatation of the peripheral bile ducts appeared on magnetic resonance cholangiopancreatography after 3 years of achieving SVR, which were consistent with primary sclerosing cholangitis.

CONCLUSION

The potential risk of developing autoimmune liver diseases after DAA treatment should be considered.

Keywords: Liver, Hepatitis C virus, Autoimmune hepatitis, Primary sclerosing cholangitis, Immune system, Case report

Core Tip: Direct-acting antivirals (DAAs) for chronic hepatitis C virus (HCV) infection are widely used as a safe and effective treatment intervention. Chronic HCV infection alters the innate and adaptive immune responses, both functionally and phenotypically. Rapid viral clearance following DAAs treatment restores adaptive immune function. Herein, we report a rare case of autoimmune hepatitis and primary sclerosing cholangitis that developed after DAAs treatment for HCV. The potential risk of developing autoimmune liver diseases after DAAs treatment owing to the restoration of host immunity following rapid viral clearance should be considered.