Type 2 Autoimmune Hepatitis Caused by Long-term Hepatitis A Virus Infection: A Case Report

Abstract

Autoimmune hepatitis (AIH) is a chronic liver disease with the incidence of 10 to 17 per 100,000 people in Europe. It affects people of any age, but most often occurs in the 40–60 age group.  The disease onset is probably associated with the impaired function of T lymphocytes, the development of molecular mimicry, intestinal dysbiosis, or infiltration with low density neutrophils, which, alongside autoantibodies. The exact cause of autoimmune hepatitis (AIH) is uncertain. Some viral infections, however, appear to be AIH triggers in people with a genetic vulnerability. We present a case of a child who developed type 2 autoimmune hepatitis as a result of HAV infection.

An eight-year-old female who was diagnosed with hepatitis A three years ago and was cured three months later. A few years later, she developed jaundice and epistaxis.

Complementary tests revealed polyclonal hypergammaglobulinemia in plasma protein electrophoresis, antinuclear and anti-LC1 antibody positivity, and hepatocyte necrotico-inflammatory lesions in a liver biopsy. The type 2 autoimmune hepatitis diagnosis was retained.

A remission was obtained under corticosteroid and azathioprine treatment. 

In cases of persistent HAV infection, AIH should be investigated so that therapy can start earlier. To prevent more serious complications, AIH patients should also receive the hepatitis B virus (HBV) and HAV vaccines. We propose that in cases of persistent liver disease caused by HAV contamination, AIH should be sought routinely in order to begin therapy as soon as possible. In addition, patients with AIH should be immunised against both hepatitis viruses, HBV and HAV, to prevent catastrophic development.