Autoimmune Hepatitis???

Liver enzymes elevated at routine check AST 103, ALT 199.  Three weeks later AST 199 ALT 378.  Also liver feels painful and swollen.  US shoned enlargement with probable fatty infiltration.  AMA and Rheumatoid Factors normal.  Hep A, B, C also neg.  SMA,S 1:40.  Severe arthralgias for past 2 months and very tired.  Used to drink light beer only but not in past month.  Gastro wants to do a liver biopsy but I'd rather him draw a few more autimmune tests first.  Sure sounds like AIH to me.  Unless light beer and some smokes while drinking could do all this.  Also have chronic thyroiditis and previous dx of erythema Nodosum.  Thanks for helping!

[mikesimon]

"Autoimmune
Anomalous presentation of human leukocyte antigen (HLA) class II on the surface of hepatocytes—possibly due to genetic predisposition or acute liver infection—causes a cell-mediated immune response against the body's own liver, resulting in autoimmune hepatitis.

Autoimmune hepatitis has an incidence of 1-2 per 100,000 per year, and a prevalence of 15-20/100,000. As with most other autoimmune diseases, it affects women much more often than men (8:1). Liver enzymes are elevated, as is bilirubin. Autoimmune hepatitis can progress to cirrhosis. Treatment is with steroids and disease-modifying antirheumatic drugs (DMARDs).

The diagnosis of autoimmune hepatitis is best achieved with a combination of clinical and laboratory findings. A number of specific antibodies found in the blood (antinuclear antibody (ANA), smooth muscle antibody (SMA), Liver/kidney microsomal antibody (LKM-1) and anti-mitochondrial antibody (AMA)) are of use, as is finding an increased Immunoglobulin G level. However, the diagnosis of autoimmune hepatitis always requires a liver biopsy. In complex cases a scoring system can be used to help determine if a patient has autoimmune hepatitis, which combines clinical and laboratory features of a given case.

Four subtypes are recognised, but the clinical utility of distinguishing subtypes is limited.

Positive ANA and SMA, raised immunoglobulin G (classic form, responds well to low dose steroids)
Positive LKM-1 (typically female children and teenagers; disease can be severe)
All antibodies negative, positive antibodies against soluble liver antigen (SLA)(now designated SLP/LP). This group behaves like group 1.
No autoantibodies detected (~13%)"


I don't know where this information is from. I had a friend who was diagnosed (incorrectly as it turned out) with AIH and I found this for him and had it filed away.
According to this article a biopsy is required in order to make a diagnosis of AIH.

Mike