Case Report and Discussion: Chronic Active Hepatitis

INTRODUCTION: In 1950, Waldenstriim reported a series of cases of chronic hepatitis in young women. This generated considerable interest in the disease. Subsequent reports have demonstrated that while it is much more prevalent in the young, it is not confined to them and that cases have been reported from all age groups. Chronic active hepatitis is a syndrome of unknown etiology, characterized by a progressive necrosis of liver parenchyma resulting in chronic hyperbilirubinemia and elevation of transaminases. Hypergammaglobulinemia is always found. The disease uniformly progresses to cirrhosis, liver failure and death. About 25 70 of cases follow what appears to be an acute attack of viral hepatitis. The remaining cases have no such antecedent history, becoming clinically recognizable at the stage of liver failure. The role of anicteric hepatitis as a predecessor of chronic active hepatitis is suspected but not proven. The prognosis is poor, most patients dying within 3-5 years from the onset of symptoms. MacKay and his colleagues (1) reported finding L.E. cells in some patients with chronic active hepatitis. He has named this entity lupoid hepatitis, making its diagnosis dependent on the presence of L. E. cells. This phenomenon suggests that autoimmunity plays a role in the etiology. Many aspects of this disease are similar to ones found in autoimmune processes. There are many problems presented by this disease. What part does viral hepatitis play in the etiology? Is there an autoimmune process perpetuating virus-induced damage? Does the L. E. cell phenomenon separate the patients into two distinct groups? Finally, how best does one treat this illness? The following case may illustrate some of these points.