29 August 2023: Articles
Co-Presentation of Lupus Nephritis with Autoimmune Hepatitis
Challenging differential diagnosis, Unusual or unexpected effect of treatment, Diagnostic / therapeutic accidents, Rare coexistence of disease or pathology
Fizah S. Chaudhary A , Amit Sureen B , Muhammad Nadeem Yousaf A , Deepthi S. Rao D , Chokkalingam Siva A*DOI: 10.12659/AJCR.940478
Am J Case Rep 2023; 24:e940478
Table 1. Characteristic features of autoimmune hepatitis and lupus hepatitis.
| Characteristics | Autoimmune hepatitis | Lupus hepatitis |
|---|---|---|
| Primary autoimmune disease | Yes | Yes |
| Associated with SLE | Rarely, often independent | Yes |
| Gender prevalence | More common in women (75–80%) | More common in women (90–95%) |
| Age of onset | Any age, peak in 30s–50s | Any age, peak in 20s–30s |
| Symptoms | Fatigue, malaise, jaundice, hepatomegaly, pruritus, arthralgias | Other features of SLE such as rash, arthritis, and serositis present |
| ANA | Variable, but often positive | Almost always positive |
| Anti-dsDNA | Rarely positive | Often positive |
| Anti-Sm antibodies | Rarely positive | Often positive |
| Anti-LKM-I antibodies | Often positive | Rarely positive |
| ASMA | Often positive | May be positive but often negative |
| AMA | Negative | Negative |
| Ribosomal-P antibody | Negative | Often positive |
| Soluble liver antigen | Often positive | Negative |
| Complement levels | May be low | May be low |
| Serum IgG Levels | Increased | May be increased or normal |
| Liver enzyme levels | Often elevated | May be elevated or normal |
| Histologic findings | Periportal piecemeal necrosis, rosette formation | Lobular inflammation more prominent |
| Plasma cells | Often present | Often present |
| Rosettes | Present | Absent |
| Fibrosis | May be present | May be present |
| ANA – antinuclear antibody; anti-dsDNA – anti-double-stranded DNA antibody; anti-Sm – Smith antibody; anti-LKM – liver kidney microsomal antibody; ASMA – anti-smooth muscle antibody; AMA – antimitochondrial antibody. | ||