Lupoid hepatitis

Certain autoimmune syndromes can be induced by drugs. Examples include systemic lupus erythematosus following hydralazine or procainamide therapy, "lupoid hepatitis" due to cathartic sensitivity, autoimmune hemolytic anemia resulting from methyldopa administration, thrombocytopenic purpura due to quinidine, and agranulocytosis due to a variety of drugs. As indicated in other... 

To a varying extent, ANA are detectable in chronic active hepatitis (CAH), in mixed forms of CAH/PBC and particularly in lupoid hepatitis (autoimmune hepatitis type I) (in 80-100%) as well as in oxyphenisatin-in-duced CAH. Clinically relevant titres start at a serum dilution of 1 80. Level of the titre, pattern of fluorescence and in particular interaction with the complement system are relevant for the pathogenic valence of ANA. The determination of ANA and SMA is indicated when autoimmune hepatitis is in question. 

Minnk, G.Y., Sutherland, L.R., Pappas, S.C., Kelley, J.K., Martin, S.E. Autoimmunic chronic active hepatitis (lupoid hepatitis) and primary sclerosing cholangitis in two young adult females. Can. J. Gastroenterol. 1988 2 22-27... 

Fig. 33.2 So-called lupoid hepatitis. The left lobe of liver shows an irregularly rippled surface (scattered light reflex) with salmon-pink and yellow colouring, patchy red marking due to highly inflammatory parenchymal zones fine vascular multiplication and whitish scarred areas with diffuse fibrosis...

Reynolds TB, Peters RL, Yamade S (1971) Chronic active and lupoid hepatitis caused by a laxative, oxyphenisation. N Engl J Med 285 813-820 Sakula A (1977) Bronchial asthma due to allergy to pancreatic extract. Lancet 2 193 Sharpe PC, Hawkins BW (1977) Efficacy and safety of cimetidine. Long-term treatment with cimetidine. In Burland WL, Simkins MA (eds) Cimetidine. Proc Second Int Symp on Histamine H2-receptor Antagonists. Excerpta Medica, Amsterdam London New York, pp 358-366... 

Recently, a case of MCTD in a male patient occupationally exposed to PVC and other toxic agents was presented. Clinical symptoms consisted of typical signs of systemic LE, rheumatoid arthritis, and lupoid hepatitis. MCTD diagnosis was confirmed serologically by the presence of u i-ribonucleoprotein-autoantibo-dies. Prednisone, 60 mg daily, produced remission (Panaszek et al. 1993). Studnicka et al. (1995) presented a 58-year-old patient exposed to thermoplastic dusts, mainly PVC, for 10 years. He developed pneumoconiosis and secondary SSc. 

This is the classical (formerly lupoid) form of autoimmune hepatitis. It shows a markedly genetic predisposition. Type 1 is the most frequently occurring form of AIH (70-80% of cases) and is mainly found in young women, especially between the ages of 20 and 40 years. There is a marked increase in y-globulins. ANA (40-70%), SMA (70-100%) (titre >1 80) and ASGPR... 

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