Autoimmune hepatitis type 2 associated with an unexpected and transient presence of primary biliary cirrhosis-specific antimitochondrial antibodies: a case study and review of the literature

BMC Gastroenterology

Giuliano Torre⁵  Raffaele Iorio²  Dimitrios P Bogdanos⁶  Manila Candusso⁵  Luca Fabris¹  Aurelio Sonzogni⁴  Ana Lleo³  Daniel S Smyk⁶  Maria Grazia Alessio⁷  Pietro Invernizzi⁸ 

[1] Center for Liver Research (CeLiveR), Ospedali Riuniti, Bergamo, Italy;Department of Pediatrics, Federico II University, Naples, Italy;Center for Autoimmune Liver Diseases, Humanitas Clinical and Research Center, Via Manzoni 56, 20089, Rozzano(MI), Italy;Department of Medicine and Transplantation, Ospedali Riuniti, Bergamo, Italy;Division of Pediatrics, Ospedali Riuniti, Bergamo, Italy;Institute of Liver Studies, King’s College London School of Medicine at King’s College Hospital, Denmark Hill Campus, London, UK;Clinical Laboratory, Ospedali Riuniti, Bergamo, Italy;Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis, Davis, CA, USA

关键词: Paediatric liver diseases.;    Environment;    Epidemiology;    Autoimmune cholangitis;    Autoimmunity;    Autoantibody;   

Others  :  1121914
DOI  :  10.1186/1471-230X-12-92

 received in 2012-01-23, accepted in 2012-07-20,  发布年份 2012

【 摘 要 】

Background

Unlike other autoimmune liver diseases, primary biliary cirrhosis (PBC) has never been reported in early childhood, while type 2 autoimmune hepatitis (AIH) is eminently a paediatric disease.

Case presentation

We describe a case of type 2 AIH with serological positivity for PBC-specific anti-mitochondrial antibodies (AMA) in a 3-year old girl. We found this observation intriguing as AMA and indeed an overlap with PBC are virtually absent in Type 2 AIH, a pediatric form of AIH which is distinct precisely because it is characterized by pathognomonic anti-liver kidney microsomal type 1 (LKM-1) showing a remarkable antigen-specificity directed against cytochrome P4502D6. We also review the literature in relation to AMA positivity in paediatric age and adolescence. In our case, the presence of AIH-2-specific anti-LKM-1 and PBC-specific AMA was confirmed by indirect immunofluorescence (IIF), and immunoblotting and ELISA based on recombinant mitochondrial antigens. The clinical, laboratory and histological features of the child are given in detail. Interestingly the mother was AMA positive without other features of PBC. The child was successfully treated with immunosuppression and five years after the original diagnosis is on a low dose of prednisolone and azathioprine, with no signs of relapse. Anti-LKM-1 antibodies are still present in low titres. AMA were detectable for the first 4 years after the diagnosis and disappeared later.

Conclusion

This is the first case report in the literature of AIH type 2 with an unexpected PBC-specific AMA positivity in a young child. Response to immunosuppressive treatment was satisfactory and similar to that described in AIH. A review of published reports on AMA positivity in paediatric age shows that the antibody may arise in the context of immunodeficiency and is variably associated with liver damage.

【 授权许可】

   
2012 Invernizzi et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

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