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20817736 tn?1521537718

How do you determine if this hepatitis is autoimmune or EBV re-infection?

Following is a summary of my medical case. I am a 40 year old mother of 3. I felt sick in December ad had a sore throat, was given antibiotics, beginning of Feb felt sick still, received antibiotics again and started having stomach pain and woke up vomitig 2 nights in a row follwed with severe jaundice.
On 2/10/2018 I went to the emergency room for severe stomach pain, light colored stools, dark urine, nausea and the whites of my eyes were yellow. Blood tests showed LFTs 20-40xs the normal range. An ultrasound revealed severe liver inflammation. My viral tests came back days later and were all negative except for EBV which showed -+++; which does not rule out re-infection. I had seen my primary care physician one month prior on 12/22 at which time my lab work showed normal LFTs (all past tests revealed no liver problems or abnormal LFTs), and was prescribed Cipro (which has been linked to DILI {Drug Induced Liver Injury} for suspected bronchitis. I mention this as my hepatologist believes this is probably autoimmune hepatitis, but he was not 100% sure AND wants me to start azaithropin and I am strongly against this medicaion due to side effects and my family history. I am currently on predinisone (started at 60mg, currently at 20mg)and my LFTs are going down with each lab test; however this could be true if it were a virus running its course. Aprox 1 week prior to my sudden onset hepatitis, my 8 year old son was diagnosed with strep-c. It took 2 different antibiotics to clear this up with him; timing of this combined with the EBV test possibly showing re-infection doesnt rule out viral. I had an MRCP done and this only showed inflammation. I had a liver biposy done (see attached), this showed severe inflammaion only (no cirrhosis or scarring), but my Dr said another biposy needs to be done after my predinisone course because infammation obscurred the view of the specimen. I met with the hepatologist one time only, he felt this was AIH but couldnt rule out DILI or viral. I tested positive for the smooth muscle antibody (was 44 latest test showed 20) and mitochondrial antibody, but was told this could be true for viral and DILI as well. I feel if this is not 100% i should not take a chemotherapy drug.
I am currently taking 20mg of predinisone a day. I have changed my diet (currently on 2nd week) to strictly gluten-free, non-GMO, no read meat or dairy. I have read where this can help with AIH and inflammation, not to mention the other positive health benefits. I have added a multi-vitamin with calcium (to offset the side effects from predinisone), flax seed oil, omega-3, CoQ10, and DHEA to my diet daily as well.
I have read studies where budesonide can have the same if not better results than azaithropin with far less side effects than predinisone. The problem is that the drug is prescribed for COPD not AIH, and long-term effects have not been sudied yet. I have read where removing gluten alone from your diet can halt the progression of AIH. Then I weigh the potential side effects of the predinisone vs azaithropin and both are alarming, but which one os best? If AIH is 100% determined, I dont know the best course of action. The hepatologist said I am responding well to the predinisone, but then said "unless its viral and in that case it may have run its course". He gave me a couple options. Take azaithropin for 2 years or wean off the predinisone and monitor my LFTs to try and predict another flare up, which we would then start treatment. He did warn against the later by saying due to the severity of my liver attack, the next one could be worse if not fatal if not caught in time. I definitely need some advice. I have attached all of my lab work from 12/22 when my LFTs were normal to current, as well as the ultrasound, MRCP, and liver biopsy results.
Thank you for your time reading though this.  

More details about the presenting complaint:
This presented very quickly ACUTE, severe liver inflammation. The predinisone worked right away and LFTs are still coming down

Previous history of the same issue:
Never had a liver problem before, gallbladder removal 2009

Current medications:
20mg predinisone

Lab tests performed:
LFTs were 1500+, total bilirubin 28 at peak of attack. one month prior they were normal
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15695260 tn?1549593113
Have you had any update since originally posting this?  
Helpful - 0
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