Case of autoimmune hepatitis with markedly enlarged hepatoduodenal ligament lymph nodes  

作　　者：Hideki Fujii Naoki Ohnishi Kazuho Shimura Masafumi Sakamoto Tohru Ohkawara Yoshihiko Sawa Koichi Nishida Yasuo Ohkawara Tatsuro Kobata Kanji Yamaguchi Yoshito Itoh 

机构地区：[1]Department of Internal Medicine,Aiseikai Yamashina Hospital,Shichouno-cho,Takehana,Yamashinaku,Kyoto 602-8086,Japan [2]Department of Gastroenterology and Hepatology,Uji Tokushukai Hospital,Kyoto 611-0042,Japan [3]Molecular Gastroenterology and Hepatology,Kyoto Prefectural University of Medicine,Graduate School of Medical Science,Kyoto 602-8566,Japan

出　　处：《World Journal of Gastroenterology》2013年第11期1834-1840,共7页世界胃肠病学杂志（英文版）

摘　　要：Autoimmune hepatitis(AIH) is a necroinflammatory liver disease of unknown etiology.The disease is characterized histologically by interface hepatitis,biochemically by increased aspartate aminotransferase and alanine aminotransferase levels,and serologically by increased autoantibodies and immunoglobulin G levels.Here we discuss AIH in a previously healthy 37-year-old male with highly elevated serum levels of soluble interleukin-2 receptor and markedly enlarged hepatoduodenal ligament lymph nodes(HLLNs,diameter,50 mm).Based on these observations,the differential diagnoses were AIH,lymphoma,or Castleman's disease.Liver biopsy revealed the features of interface hepatitis without bridging fibrosis along with plasma cell infiltration which is the typical characteristics of acute AIH.Lymph node biopsy revealed lymphoid follicles with inflammatory lymphocytic infiltration;immunohistochemical examination excluded the presence of lymphoma cells.Thereafter,he was administered corticosteroid therapy:after 2 mo,the enlarged liver reached an almost normal size and the enlarged HLLNs reduced in size.We could not find AIH cases with such enlarged lymph nodes(diameter,50 mm) in our literature review.Hence,we speculate that markedly enlarged lymph nodes observed in our patient may be caused by a highly activated,humoral immune response in AIH.Autoimmune hepatitis (AIH) is a necroinflammatory liver disease of unknown etiology. The disease is characterized histologically by interface hepatitis, biochemically by increased aspartate aminotransferase and alanine aminotransferase levels, and serologically by increased autoantibodies and immunoglobulin G levels. Here we discuss AIH in a previously healthy 37-year-old male with highly elevated serum levels of soluble interleukin-2 receptor and markedly enlarged hepatoduodenal ligament lymph nodes (HLLNs, diameter, 50 mm). Based on these observations, the differential diagnoses were AIH, lymphoma, or Castleman’s disease. Liver biopsy revealed the features of interface hepatitis without bridging fibrosis along with plasma cell infiltration which is the typical characteristics of acute AIH. Lymph node biopsy revealed lymphoid follicles with inflammatory lymphocytic infiltration; immunohistochemical examination excluded the presence of lymphoma cells. Thereafter, he was administered corticosteroid therapy: after 2 mo, the enlarged liver reached an almost normal size and the enlarged HLLNs reduced in size. We could not find AIH cases with such enlarged lymph nodes (diameter, 50 mm) in our literature review. Hence, we speculate that markedly enlarged lymph nodes observed in our patient may be caused by a highly activated, humoral immune response in AIH.

关 键 词：Autoimmune hepatitis HUMORAL immune response Hepatoduodenal ligament LYMPH nodes CORTICOSTEROID HEPATOMEGALY 

分 类 号：R575.1[医药卫生—消化系统]