背景:溃疡性结肠炎(UC)是一种炎症性肠病(IBD),其特征是结肠粘膜持续发炎。自身免疫性肝炎(AIH)是一种慢性肝病,其特征是高丙种球蛋白血症,循环自身抗体,界面肝炎,和对免疫抑制的良好反应。IBD和AIH之间的关联并不常见,专家建议,在重叠的IBD和AIH患者中,可以使用抗肿瘤坏死因子剂。因此,本研究报告了一例罕见的AIH和UC导致的肝硬化患者,该患者对常规治疗无效,并讨论了在这两种情况下使用抗肿瘤坏死因子的风险和益处.
方法:一名28岁女性出现腹泻症状,腹痛,虚弱,和食欲不振,伴有腹部侧支循环,贫血,肝酶的改变,和C反应蛋白水平升高。
方法:患者接受了肝活检,这与AIH引起的肝硬化一致。结肠镜检查显示整个结肠有炎症过程,与中等活性UC兼容。
方法:患者接受美沙拉嗪,硫唑嘌呤,和皮质治疗,没有控制炎症过程。面对难治性药物治疗和糖皮质激素的副作用,肝硬化导致严重感染的风险增加,我们选择使用英夫利昔单抗治疗UC.患者出现临床反应,英夫利昔单抗治疗得以维持。
结果:开始英夫利昔单抗治疗8个月后,患者出现肺炎,伴有弥散性血管内凝血并发症并死亡.
■AIH是UC患者转氨酶水平升高的罕见原因。控制这两种情况的最佳治疗方法应警惕药物的副作用,主要是感染,尤其是肝硬化患者。
BACKGROUND: Ulcerative colitis (UC) is an inflammatory bowel disease (IBD) characterized by continuous inflammation of the colonic mucosa. Autoimmune hepatitis (AIH) is a chronic liver disease characterized by hypergammaglobulinemia, circulating autoantibodies, interface hepatitis, and favorable response to immunosuppression. An association between IBD and AIH is uncommon, and experts have suggested that in patients with overlapping IBD and AIH, the anti-tumor necrosis factor agents can be used. Therefore, this study reports a rare case of a patient with liver cirrhosis due to AIH and UC refractory to conventional treatment and discusses the risks and benefits of using anti-tumor necrosis factor in both conditions.
METHODS: A 28-year-old female presented with symptoms of diarrhea, abdominal pain, asthenia, and inappetence, accompanied by abdominal collateral circulation, anemia, alteration of liver enzymes, and elevation of C-reactive protein levels.
METHODS: The patient underwent a liver biopsy, which was consistent with liver cirrhosis due to AIH. Colonoscopy showed an inflammatory process throughout the colon, compatible with moderately active UC.
METHODS: The patient received mesalazine, azathioprine, and corticotherapy, with no control of the inflammatory process. Faced with refractoriness to drug treatment and side effects of corticosteroids with an increased risk of severe infection due to cirrhosis, we opted to use infliximab for the treatment of UC. The patient presented with a clinical response and infliximab therapy was maintained.
RESULTS: Eight months after starting infliximab therapy, the patient developed pneumonia with complications from disseminated intravascular coagulation and died.
UNASSIGNED: AIH is a rare cause of elevated transaminase levels in patients with UC. The best treatment to control the 2 conditions should be evaluated with vigilance for the side effects of medications, mainly infections, especially in patients with cirrhosis.