Successful cyclosporine treatment for a case with acute-onset autoimmune hepatitis presenting as severe type

Abstract

A 42-year-old woman was admitted to our hospital because of acute hepatitis severe type. She had no history of disease except for thyroid dysfunction, and serological tests for viral hepatitis were all negative. Anti-nuclear antibody (×40) and HLA DR4 were positive, and IgG was 2,220 mg/dl. Although we suspected autoimmune hepatitis (AIH) because of an AIH score 13 points and conducted corticosteroid pulse therapy followed by prednisolone at a dose of 60 mg/day, her symptoms and laboratory data did not improve. Moreover, computed tomography showed marked liver atrophy and ascites. Therefore, we administered cyclosporine in combination with prednisolone. After starting combination therapy, her liver function improved gradually. Consequently, her AIH score reached 18 points and she was diagnosed with AIH. Currently, she is in remission and receiving prednisolone alone at a dose of 8 mg/day. This case suggests that cyclosporine is effective in preventing acute-onset AIH from progressing to fulminant hepatitis.