Acute onset autoimmune hepatitis in pregnancy complicated with fetal ascites: A case report

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  • Fushimi Takashi
    Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine
  • Koga Hironori
    Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine
  • Kozuma Yutaka
    Department of Obstetrics and Gynecology, Kurume University School of Medicine
  • Arinaga-Hino Teruko
    Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine
  • Torimura Takuji
    Liver Cancer Research Division, Kurume University Research Center for Innovative Cancer Therapy
  • Hori Daizo
    Department of Obstetrics and Gynecology, Kurume University School of Medicine
  • Kamura Toshiharu
    Department of Obstetrics and Gynecology, Kurume University School of Medicine
  • Sata Michio
    Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine

Bibliographic Information

Other Title
  • 妊娠中に発症し胎児に腹水を認めた自己免疫性肝炎の1例
  • 症例報告 妊娠中に発症し胎児に腹水を認めた自己免疫性肝炎の1例
  • ショウレイ ホウコク ニンシン チュウ ニ ハッショウ シ タイジ ニ フクスイ オ ミトメタ ジコ メンエキセイ カンエン ノ 1レイ

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Abstract

A 31-year old pregnant female complained skin itching and sleep disturbance at 14 weeks of her second pregnancy. At 20 weeks of the pregnancy, jaundice was noted and she was admitted to our hospital. Despite of intensive examination, including assays for viral infections and auto-antibodies such as anti-nuclear antibody, etiology of the jaundice-causing hepatitis was not determined. Since hepatoprotective therapies did not improve her liver function or fetal ascites diagnosed by ultrasonography, termination of pregnancy was performed at her and her family's desire at 21 weeks and 6 days of her pregnancy. Immediately after the termination, her liver function turned to be improved. Two weeks after the termination, however, serum levels of transaminases were sharply re-elevated (i.e., 367 IU/mL in ALT). Based on the histological diagnosis for AIH, predonisolone therapy (40 mg/body) was started, showing favorable response to ameliorate her liver function immediately. Although trigger for both maternal AIH and fetal ascites was unclear, breakdown of maternal-fetal immune tolerance might be involved.

Journal

  • Kanzo

    Kanzo 54 (11), 780-786, 2013

    The Japan Society of Hepatology

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