Dass L, Pacia AMM, Hamidi M. Acute hepatitis of unknown etiology in an adult female: A case report. World J Clin Cases 2023; 11(22): 5288-5295 [PMID: 37621598 DOI: 10.12998/wjcc.v11.i22.5288]
Corresponding Author of This Article
Lucinda Dass, MD, Doctor, Department of Clinical Studies, St. George's University, University Centre Grenada, True Blue 00000, Grenada. lucinda.dass95@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Aug 6, 2023; 11(22): 5288-5295 Published online Aug 6, 2023. doi: 10.12998/wjcc.v11.i22.5288
Acute hepatitis of unknown etiology in an adult female: A case report
Lucinda Dass, Alexandra Marie Malabanan Pacia, Mahgol Hamidi
Lucinda Dass, Mahgol Hamidi, Department of Clinical Studies, St. George's University, True Blue 00000, Grenada
Alexandra Marie Malabanan Pacia, Department of Internal Medicine, Jersey City Medical Center, Jersey City, New Jersey 07307, United States
Author contributions: Dass L, Pacia A, and Hamidi M contributed to manuscript writing and editing, as well as data collection; all authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
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: Lucinda Dass, MD, Doctor, Department of Clinical Studies, St. George's University, University Centre Grenada, True Blue 00000, Grenada. lucinda.dass95@gmail.com
Received: April 4, 2023 Peer-review started: April 4, 2023 First decision: May 11, 2023 Revised: June 7, 2023 Accepted: June 30, 2023 Article in press: June 30, 2023 Published online: August 6, 2023
Abstract
BACKGROUND
Acute liver injury (ALI) refers to inflammation of the hepatic parenchyma without hepatic encephalopathy that lasts less than 6 mo. When the etiology is unknown, Acute Hepatitis of Unknown Origin (AHUO) can present as a diagnostic and treatment challenge. AHUO in the adult population is unusual and poorly documented. It has an incidence between 11% and 75%. Currently, no treatment guidelines exist. With no identified cause, treatment is often blind, and the wrong treatment plan may have unintended consequences.
CASE SUMMARY
We present the case of a 58-year-old woman who presented to the emergency room for elevated liver function tests (LFTs). Her symptoms started 10 d prior to admission and included nausea, vomiting, jaundice, decreased appetite, weight loss of 10 lbs, and dark urine. She denied drinking alcohol or taking any hepatotoxic agents, including acetaminophen, statins, vitamins, or supplements. She was admitted to the hospital, and an etiologic work-up was carried out. Her initial bloodwork revealed elevated liver enzymes (alanine aminotransferase 2500 U/L, aspartate aminotransferase 3159 U/L, and alkaline phosphatase 714 U/L) and elevated total bilirubin of 6.4 mg/dL. She tested negative for common infectious etiologies such as hepatotropic viruses A, B, C, and E. Further infective work-up revealed negative serology for cytomegalovirus, Epstein-Barr virus, herpes simplex virus 1 & 2, and human immunodeficiency virus. Her autoantibody test results were negative, including anti-smooth muscle antibody, anti-mitochondrial antibody, and anti-liver kidney microsome 1 antibody. Magnetic resonance cholangiopancreatography ruled out biliary causes of elevated LFTs, and her core liver biopsy proved inconclusive. Over the course of her hospital stay, the patient's LFTs improved with supportive care and without steroids.
CONCLUSION
Idiopathic hepatitis makes treatment challenging. It can leave patients feeling confused and unfulfilled. Thus, educating the patient thoroughly for shared decision-making and management becomes essential.
Core Tip: Despite a thorough work-up (history, physical, labs, etc.), the etiology of acute hepatitis may remain a mystery. While common in children, this medically challenging situation is rare and understudied in adults. A review of the current literature reveals that the incidence is between 11% and 75%, yet no clear treatment guideline exists. Below we report the case of a 58-year-old woman with symptomatic acute hepatitis with unknown etiology, and we describe the treatment plan and rationale. In general, steroids could be considered as a possible treatment for acute hepatitis of unknown etiology. However, it was ultimately not used in our patient because of the potential risk of adverse side effects from steroid use, and an infectious etiology could not be definitively ruled out. In this situation, patient education was essential for shared decision making.
