Bridgeport Hospital, Yale University School of Medicine Bridgeport, CT, United States
Sameer Dawoodi, MD Bridgeport Hospital, Yale University School of Medicine, Bridgeport, CT
Introduction: Fetal micro chimerism is the study of persisting fetal cells in the mother years after pregnancy. Due to the association between pregnancy and autoimmune disease (AID), laboratory studies have for years attempted to link microchimeric fetal cells with the onset of AID after pregnancy.
We describe a case of a young female who developed Autoimmune Hepatitis (AIH) 6 months after cesarean section delivery.
Case Description/Methods: 23-year-old female presented with complaints of fatigue, headache and RUQ abdominal pain for 2 weeks associated with nausea and vomiting. Relevant past medical history included pregnancy— complicated by preeclampsia 6 months prior—treated with labetalol. Current medications included labetalol and multivitamins. She denied use of herbal supplements, pain medications—Tylenol, weight loss supplements. On examination, scleral icterus was prominent, otherwise unremarkable. Initial labs— AST 1228, ALT 2185, alkaline phosphatase 121, total bilirubin 6.1, direct bilirubin 4.7, INR 1.4. RUQ US unremarkable. Complete liver workup— viral hepatitis panel, autoimmune ( IgG level: normal, ANA positive: 1: 1280), metabolic ( iron panel, ceruloplasmin)— all unremarkable. During the admission, liver enzymes remained elevated but flat. Following symptomatic improvement, the patient was discharged after a liver biopsy. The pathology was suggestive of AIH thus the patient was treated with systemic steroids with dramatic improvement in her liver chemistries.
Discussion: The patient had normalization of transaminases while on labetalol thus unlikely to be DILI. Given the biopsy findings and elevated ANA titers there was a high suspicion for AIH despite normal total IgG. AID is more common among women with increased incidence after pregnancy. The “fetal micro chimerism” hypothesis of AID is supported by similarities of chronic graft-versus-host-disease to some autoimmune conditions & their predilection for women post-partum. There is more fetal cell traffic across the placenta in certain complications of pregnancy such as pre-eclampsia, and there is greater fetal cell traffic with operative delivery compared to normal vaginal delivery. Understanding why autoimmune disease develops after pregnancy may help design future treatments for these varied disease processes. If the ‘missing link’ is fetal cells persisting in the mother after pregnancy, then while fetal cell traffic cannot be prevented, it could be manipulated or influenced.
Disclosures: Sameer Dawoodi indicated no relevant financial relationships.
Sameer Dawoodi, MD. P1901 - Autoimmune Hepatitis Post-Partum, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.