Type I autoimmune hepatitis, inverted psoriasis with psoriatic arthropathy and type 2 diabetes mellitus as complications of a chronic B virus hepatitis treated with interferon - Case report

Introduction Autoimmune hepatitis is a chronic liver inflammatory condition, with possible progressive evolution towards liver cirrhosis, characterized by the presence of liver inflammation, peace-meal liver necrosis and specific serum autoantibodies (Longhi et al 2010). The disease may accompany other autoimmune conditions and the main therapeutic resources are glucocorticoids and immunosuppressants. AH could also accompany chronic viral hepatitis among overlap syndromes or could be triggered by these infections or their therapy (Tripathi et al 2009). At the moment, the majority of the authors accept 2 types of AH (table 1). Psoriasis is an autoimmune inflammatory disease, characterized by infiltration of epidermis by T-cell lymphocytes that produce cytokines capable of inducing keratinocytes proliferation. Keratocytes stimulated this way are capable of inducing T-cell stimulation, the result being the development of specific cutaneous lesions in areas subjected to mechanical friction (Pietrzak et al 2008). In inverted psoriasis the lesions appear on flexion folds. A group of patients with psoriasis develop psoriatic arthritis, a form of seronegative spondilarthritis with genetic mark of HLA B 27 (Menter et al 2010). T1DM is an autoimmune condition resulting consecutively the destruction of ß pancreatic islet cells and may be accompanied by various syndromatic or nonsyndromatic autoimmune diseases. In the description of T2DM, immunologic paradigm, neglected till recently, becomes gradually of some importance (DiPenta et al 2007).