Abstract
An 80-year-old woman visited our department because she was told to have impaired hepatic function by a local doctor. At presentation, AST (423 IU/l), ALT (222 IU/l), ALP (481 IU/l) and T-Bil (6.7 mg/dl) were all elevated, with a positive antinuclear antibody test (1 : 160). IgG was increased to 3238 mg/dl, and the IgM-HA antibody test was positive. The total score for the diagnostic scoring system developed by the International Autoimmune Hepatitis Group was 12, corresponding to a "probable" diagnosis. Thus, AIH was suspected as the underlying cause. The RT-PCR analysis of her serum sample revealed HAV-RNA, suggesting infection with hepatitis A virus (HAV). She was asked to take bed rest and observed, but AST and ALT remained elevated. A liver biopsy revealed histopathological findings consistent with a diagnosis of AIH. Oral predonisolone was initiated, which resulted in a rapid improvement in liver function. Here, we report this case of acute exacerbation of AIH, accompanied by HAV infection, in a senile woman.
