Association of an overlap syndrome of autoimmune hepatitis and primary biliary cirrhosis with cytomegalovirus infection

Abstract

Megumi Toyoda-Akui1,4, Hiroaki Yokomori1, Fumihiko Kaneko1,4, Yuki Shimizu1, Hajime Takeuchi1, Kumiko Tahara1, Hide Yoshida1, Hirobumi Kondo1, Tadashi Motoori2, Makoto Ohbu3, Masaya Oda5, Toshifumi Hibi61Department of Internal Medicine, 2Division of Pathology, Kitasato Medical Center Hospital, Kitasato University, Saitama; 3Department of Pathology, School of Allied Health Sciences, Kitasato University, Sagamihara, Kanagawa; 4Department of Internal Medicine, Saitama Social Insurance Hospital, Saitama; 5Organized Center of Clinical Medicine, International University of Health and Welfare, Tokyo; 6Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, JapanAbstract: A 63-year-old woman, who presented with severe jaundice and elevated serum conjugated bilirubin level, denied alcohol and drug use and showed no evidence of viral hepatitis. Based on clinical and laboratory features, she was diagnosed with autoimmune hepatitis with primary biliary cirrhosis. Hematological and immunochemical assays, radiographic imaging, clinical examination, and liver biopsy were conducted. Laboratory results were the following: negative for fluorescence antinuclear antibody, negative for antismooth muscle antibodies but positive for antinuclear antibody (enzyme-linked immunosorbent assay) and antimitochondrial M2 antibody, high titers of serum globulin, and positive for cytomegalovirus IgM. Liver biopsy showed submassive lobular necrosis, inflammation with broad areas of parenchymal collapse, and chronic nonsuppurative destructive cholangitis. The patient responded well to corticosteroid therapy. This case might illustrate an association between cytomegalovirus infection and the occurrence of autoimmune hepatitis.Keywords: autoimmune hepatitis, fluorescence antinuclear antibody, enzyme linked immuno sorbent assay, primary biliary cirrhosis, cytomegalovirus infection