Case Report
Copyright ©2014 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 21, 2014; 20(35): 12662-12667
Published online Sep 21, 2014. doi: 10.3748/wjg.v20.i35.12662
Association of autoimmune hepatitis and systemic lupus erythematodes: A case series and review of the literature
Claudia Beisel, Christina Weiler-Normann, Andreas Teufel, Ansgar W Lohse
Claudia Beisel, Christina Weiler-Normann, Ansgar W Lohse, Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
Andreas Teufel, Department of Internal Medicine, Johannes Gutenberg Universität Mainz, 55122 Mainz, Germany
Andreas Teufel, Department of Internal Medicine, University Hospital Regensburg, 55122 Mainz, Germany
Author contributions: All authors participated in the diagnosis, management and follow-up of this clinical case and have reviewed, corrected and approved this final version of the manuscript.
Correspondence to: Claudia Beisel, MD, Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany.
Telephone: +49-40-741053910 Fax: +49-40-741058531
Received: March 18, 2014
Revised: May 18, 2014
Accepted: June 14, 2014
Published online: September 21, 2014

Liver test abnormalities have been described in up to 60% of patients with systemic lupus erythematodes (SLE) at some point during the course of their disease. Prior treatment with potentially hepatotoxic drugs or viral hepatitis is commonly considered to be the main cause of liver disease in SLE patients. However, in rare cases elevated liver enzymes may be due to concurrent autoimmune hepatitis (AIH). To distinguish whether the patient has primary liver disease with associated autoimmune clinical and laboratory features resembling SLE - such as AIH - or the elevation of liver enzymes is a manifestation of SLE remains a difficult challenge for the treating physician. Here, we present six female patients with complex autoimmune disorders and hepatitis. Patient charts were reviewed in order to investigate the complex relationship between SLE and AIH. All patients had coexisting autoimmune disease in their medical history. At the time of diagnosis of AIH, patients presented with arthralgia, abdominal complaints, cutaneous involvement and fatigue as common symptoms. All patients fulfilled the current diagnostic criteria of both, AIH and SLE. Remission of acute hepatitis was achieved in all cases after the initiation of immunosuppressive therapy. In addition to this case study a literature review was conducted.

Keywords: Systemic lupus erythematodes, Elevated liver enzymes, Autoimmune hepatitis

Core tip: Hepatic involvement in patients with systemic lupus erythematodes (SLE) is considered to be rare. The differences between hepatic involvement caused by hepatotoxic drugs, coincident viral hepatitis, non-alcoholic fatty liver disease or concurrent autoimmune hepatitis (AIH) as independent disease has not been defined clearly in patients with SLE. This case report describes six patients who fulfill the current diagnostic criteria for both SLE and AIH, and thus represents the largest case series in the literature.