P2184 - Auto-Immune Hepatitis - An Unusual Age at Presentation

Navyamani Kagita, MD¹, Bhanusowmya Buragamadagu, MD², Aisha Sultana Shaik, MD², Vihitha Thota, MD³, Sabah Iqbal, MD², Sana Mulla, MD², Aliza Khanam, MD², Steven Russell, MD^2
1Mercy Fitzgerald Hospital, Darby, PA; ²Mercy Catholic Medical Center, Darby, PA; ³Mercy Catholic Medical Center, Lansdowne, PA

Introduction: Autoimmune hepatitis (AIH) is a T-cell immune-mediated chronic inflammatory liver disease that epidemiologically has been observed to present in a bimodal age distribution with the first peak between the ages of 10-20 and the second peak between the ages of 45-70. Here, we present a case of AIH in a woman >75 years of age presenting with non-specific gastrointestinal symptoms.

Case Description/Methods: A 78-year-old woman with a history of hypertension on hydrochlorothiazide presented with complaints of nausea, vomiting, diarrhea, and one episode of bright red blood per rectum. There was no abdominal tenderness on examination. Laboratory analysis revealed anemia, thrombocytopenia, elevated lipase, bilirubin, and liver enzymes with aspartate transaminase of 411U/L, alanine transaminase of 240U/L, and alkaline phosphatase of 147U/L. Computed tomography (CT) of the abdomen showed features of acute pancreatitis. Hemoglobin remained stable and the patient had no further episodes of gastrointestinal bleeding. Progressive elevation in bilirubin with subsequent development of jaundice and worsening fatigue prompted further investigation. Workup revealed hepatic cirrhosis with ascites on liver imaging, positive antinuclear antibody (ANA) and anti-smooth muscle antibody (ASMA), increased immunoglobulin G (IgG) level, and negative viral hepatitis panel. Liver biopsy showed features of cirrhosis in addition to peri-portal and lobular chronic inflammation with lymphocytes and plasma cells. Given the patient's positive ANA, ASMA, in conjunction with histologic findings, AIH was diagnosed and prednisone was initiated, with marked improvement in clinical symptoms and liver enzymes.

Discussion: ^{AIH has a broad spectrum of clinical presentations ranging from no symptoms to features of fulminant hepatic failure. Genetic factors, viral infection, and hepatotoxic drugs predispose patients to developing AIH, among other factors. Women are more commonly affected, with a bimodal age distribution. AIH should be suspected with elevated aminotransferase levels and elevated IgG; seropositivity for ANA, ASMA is usually also present. Diagnosis is made with a liver biopsy, and glucocorticoids alone or in combination with azathioprine are the mainstay of treatment. Response failure to medication with progression of liver disease may require liver transplantation, especially in the setting of fulminant or end-stage liver failure. Therefore, prompt investigation and timely treatment can prevent catastrophic outcomes.}


Disclosures:
Navyamani Kagita indicated no relevant financial relationships.
Bhanusowmya Buragamadagu indicated no relevant financial relationships.
Aisha Sultana Shaik indicated no relevant financial relationships.
Vihitha Thota indicated no relevant financial relationships.
Sabah Iqbal indicated no relevant financial relationships.
Sana Mulla indicated no relevant financial relationships.
Aliza Khanam indicated no relevant financial relationships.
Steven Russell indicated no relevant financial relationships.


Navyamani Kagita, MD¹, Bhanusowmya Buragamadagu, MD², Aisha Sultana Shaik, MD², Vihitha Thota, MD³, Sabah Iqbal, MD², Sana Mulla, MD², Aliza Khanam, MD², Steven Russell, MD². P2184 - Auto-Immune Hepatitis - An Unusual Age at Presentation, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.