背景:急性肝损伤(ALI)是指持续少于6个月的无肝性脑病的肝实质炎症。当病因不明时,未知来源的急性肝炎(AHUO)可以作为诊断和治疗挑战。成人人口中的AHUO是不寻常的,记录很少。发病率在11%到75%之间。目前,没有治疗指南。没有明确的原因,治疗往往是盲目的,错误的治疗方案可能会产生意想不到的后果。
方法:我们介绍了一名58岁女性,她到急诊室接受肝功能升高检查(LFTs)。她的症状在入院前10天开始,包括恶心,呕吐,黄疸,食欲下降,体重减轻10磅,和深色尿液。她否认饮酒或服用任何肝毒性药物,包括对乙酰氨基酚,他汀类药物,维生素,或补充。她被送进了医院,并进行了病因学检查。她最初的血液检查显示肝酶升高(丙氨酸转氨酶2500U/L,天冬氨酸转氨酶3159U/L,和碱性磷酸酶714U/L),总胆红素升高6.4mg/dL。她对常见的感染病因如嗜肝病毒A检测呈阴性,B,C,和E.进一步的感染检查显示巨细胞病毒血清学阴性,爱泼斯坦-巴尔病毒,单纯疱疹病毒1和2和人类免疫缺陷病毒。她的自身抗体检测结果为阴性,包括抗平滑肌抗体,抗线粒体抗体,和抗肝肾微粒体1抗体。磁共振胰胆管成像排除了LFTs升高的胆道原因,她的核心肝活检没有定论。在她住院的过程中,患者的LFTs在支持治疗和无类固醇治疗下得到改善。
结论:特发性肝炎使治疗具有挑战性。这会让患者感到困惑和无法满足。因此,彻底教育患者共同决策和管理变得至关重要。
BACKGROUND: Acute liver injury (ALI) refers to inflammation of the hepatic parenchyma without hepatic encephalopathy that lasts less than 6 mo. When the etiology is unknown, Acute Hepatitis of Unknown Origin (AHUO) can present as a diagnostic and treatment challenge. AHUO in the adult population is unusual and poorly documented. It has an incidence between 11% and 75%. Currently, no treatment guidelines exist. With no identified cause, treatment is often blind, and the wrong treatment plan may have unintended consequences.
METHODS: We present the
case of a 58-year-old woman who presented to the emergency room for elevated liver function tests (LFTs). Her symptoms started 10 d prior to admission and included nausea, vomiting, jaundice, decreased appetite, weight loss of 10 lbs, and dark urine. She denied drinking alcohol or taking any hepatotoxic agents, including acetaminophen, statins, vitamins, or supplements. She was admitted to the hospital, and an etiologic work-up was carried out. Her initial bloodwork revealed elevated liver enzymes (alanine aminotransferase 2500 U/L, aspartate aminotransferase 3159 U/L, and alkaline phosphatase 714 U/L) and elevated total bilirubin of 6.4 mg/dL. She tested negative for common infectious etiologies such as hepatotropic viruses A, B, C, and E. Further infective work-up revealed negative serology for cytomegalovirus, Epstein-Barr virus, herpes simplex virus 1 & 2, and human immunodeficiency virus. Her autoantibody test results were negative, including anti-smooth muscle antibody, anti-mitochondrial antibody, and anti-liver kidney microsome 1 antibody. Magnetic resonance cholangiopancreatography ruled out biliary causes of elevated LFTs, and her core liver biopsy proved inconclusive. Over the course of her hospital stay, the patient\'s LFTs improved with supportive care and without steroids.
CONCLUSIONS: Idiopathic hepatitis makes treatment challenging. It can leave patients feeling confused and unfulfilled. Thus, educating the patient thoroughly for shared decision-making and management becomes essential.