Lupus Hepatitis and Autoimmune Hepatitis (Lupoid Hepatitis)

Liver dysfunction occurs in approximately 50% of patients with systemic lupus erythematosus (SLE), and patients with SLE and elevated liver enzymes can present a complicated and difficult differential diagnosis. Lupus hepatitis and autoimmune hepatitis are 2 immunologic conditions involving the liver, which can have similar clinical, laboratory and systemic presentations, leading to difficulties in diagnosis. Physicians need to be aware of these 2 hepatic diseases as diagnosis and appropriate therapy need to occur early in the disease course to prevent progression to advanced liver disease. We review the liver diseases associated with SLE and discuss the approach to the diagnostic evaluation of these patients. In particular, differentiation between lupus hepatitis and autoimmune hepatitis requires careful clinical and often histologic evaluation.     

Idiopathic Autoimmune Chronic Hepatitis Triggered by Hepatitis A

Hepatitis A virus (HAV) infection is a well-recognized cause of acute hepatitis with jaundice in adults. However, chronic sequelae of HAV infection are so rare and so poorly defined that their existence remains speculative. In this report we describe a middle-aged woman in whom serologically defined acute hepatitis A appeared to trigger the onset of autoimmune chronic active hepatitis. This and two previously reported cases suggest that in certain individuals, presumably with a genetic predisposition to tbe development of autoimmune bepatitis, HAV infection may be tbe precipitating event in tbe patbogenesis of tbis disorder.     

Autoimmune Hepatitis Induced after Treatment of Syphilitic Hepatitis

We present a unique case of biopsy-proven syphilitic hepa-titis which presented as severe acute liver injury with sig-nificant elevation in aminotransferases an...     

Hepatitis C

In the latter half of the 20th century, HCV emerged as the most common cause of chronic liver disease, and will likely remain so. Since its initial discovery in 1989, rapid progress has been made in our understanding of the virology, epidemiology, natural history, diagnosis, and treatment of HCV. Over the next few decades, as further advancements are made, superior treatment options will become available.     

Shigella Hepatitis

A 17-year old girl developed Shigella dysentery. She also developed cholestatic hepatitis which was evident by the sixth day of illness and subsided with the clinical improvement of shigellosis. This may be the first biopsy proven case of hepatitis in endemic shigellosis.     

自身免疫性肝炎

自身免疫性肝炎(autoimmune hepatitis,AIH)是一类以自身免疫反应为基础,以高丙种球蛋白血症、高血清自身抗体为特征的肝脏炎症性病变。汇管区大量浆细胞浸润并向周围肝实质侵入形成界板炎症是其典型病理组织学特征[1]。此病多见于女性(男女比例为 1:3.6),任何年龄均可发病。如不治疗易发展为肝硬化,免疫抑制剂对其显示一定疗效。病因及发病机制自身免疫性肝炎的病因及发病机制尚不清楚,遗传易感性被认为是主要因素,而病毒感染、环境和药物则可能是在遗传易感基础上的促发因素[2~3]。激发AIH的抗原目前尚不清楚,表达在肝细胞表面的肝…     

Hepatitis E

Hepatitis E, previously known as enterically transmitted non-A, non-B hepatitis, is an infectious viral disease with clinical and morphologic features of acute hepatitis. Its causative agent, hepatitis E virus, consists of small, 32- to 34-nm diameter, icosahedral, nonenveloped particles with a single-stranded, positive-sense, 7.5-kb RNA. The virus has two main geographically distinct strains, Asian and Mexican; recently, novel isolates from nonendemic areas and a genetically related swine HEV have been described. HEV is responsible for large epidemics of acute hepatitis and a proportion of sporadic hepatitis cases in the Indian subcontinent, southeast and central Asia, the Middle East, parts of Africa, and Mexico. The virus is excreted in feces and is transmitted predominantly by fecal-oral route, usually through contaminated water. Person-to-person transmission is uncommon. Clinical attack rates are the highest among young adults. Recent evidence suggests that humans with subclinical HEV infection and animals may represent reservoirs of HEV; however, further data are needed. Diagnosis of hepatitis E is usually made by detection of specific IgM antibody, which disappears rapidly over a few months; IgG anti-HEV persists for at least a few years. Clinical illness is similar to other forms of acute viral hepatitis except in pregnant women, in whom illness is particularly severe with a high mortality rate. Subclinical and unapparent infections may occur; however, chronic infection is unknown. No specific treatment is yet available. Use of clean drinking water and proper sanitation is currently the most effective method of prevention. Passive immunization has not been proved to be effective, and recombinant vaccines for travelers to disease-endemic areas and for pregnant women currently are being developed.     

Hepatitis A

Known properties of hepatitis A virus are described in this article. HAV is a small non-enveloped picornavirus, grouped in the Enterovirus family, with unique biological features. The genome structure resembles that of other picornaviruses. Replication in cell cultures takes much longer than that of other picornaviruses and the yield is much lower. HAV is extremely heat- and pH-stable. Variants may induce cytopathogenic effects in vitro. Normally, however, the virus is non-cytopathogenic. The elimination of virus in vivo is assumed to be caused by action of HAV antigen specific CD8+ lymphocytes. In industrialized countries there is a declining incidence of reported hepatitis A cases, and the prevalence of antibodies in younger populations is low. Vaccines have been developed and in studies using human volunteers, good immunogenicity has been demonstrated. In the very near future a cell cultured derived, highly purified, inactivated vaccine will be available.