Autoimmune hepatitis and hepatic arteritis.

Autoimmune hepatitis and hepatic arteritis SIR, The presence of hepatic arteritis is a common finding in the hepatic biopsies of patients with PAN. Nevertheless, its impact on other collagen-vascular diseases (CVDs) is much lower. In an extensive pathological series of 120 autopsies and 40 hepatic in vivo biopsies taken from patients with a history of CVD, Matsumoto found signs of liver arteritis in 100% of patients with PAN, but in only 18% of patients with SLE, the last all belonging to autopsy samples [1]. So far the association between hepatic arteritis and autoimmune hepatitis (AIH) has not been published. We report a patient with a diagnosis of AIH and a simultaneous histological finding of hepatic vasculitis. The patient was a 62-year-old woman with a medical history of a mild self-limiting neutropoenia episode during the post-operative period after a hysterectomy due to myomas 10 years earlier. The patient was admitted to our hospital due to a 1 week clinical picture of intense asthaenia, jaundice and coluria. She was not taking medicines or herbal products, and was not suffering from dry eye syndrome, photosensitivity, oral aphthae, alopecia or Raynaud's disease. Physical examination highlighted cutaneous-mucous jaundice and a 3-cm painful hepatomegaly. The analysis revealed thrombopoenia (platelet count of 44 000/ml). The PT and activated partial thromboplastin time were 18 and 21.6 s, respectively. Complement component 4 was decreased (3.6 mg/dl). Bilirubin was 14.8 mg/dl, aspartate aminotransferase was 1272 IU/l, alanine aminotransferase was 1120 IU/l, ALP was 711 IU/l and g-glutamyl transpeptidase was 123 IU/l. The g-globulin levels were elevated with IgG 2790 mg/dl. Antibody studies were positive for ANA (1/320, nucleolar pattern), anti-dsDNA (1/320) and anti-Ro/SSA, and negative for RF, ANCA, AMA, ASMA, lupus-like circulating anti-coagulant, antibodies to liver kidney microsome, anti-cardiolipin, b 2-glycoprotein I, soluble liver antigen and CCP. Cryoglobulins were negative. Serologies for hepatotropic virus were negative and ceruloplasmin and a-1 anti-trypsin levels were normal. Quantification of proteins in urine was 0.24 g/24 h. Abdominal US showed a normal-sized liver. We did a transjugular biopsy of the liver, and the histopathological study showed the FIG. 1 AIH with arteritis. (a) Interface hepatitis with erosive hepatocellular necrosis. Numerous plasma cells (arrows), a common finding in AIH, are seen in the infiltrate. (b) An arteriole with a focus of necrotizing vasculitis, which is characterized by fibrinoid necrosis of its wall accompanied by a neutrophilic infiltrate with nuclear dust.