Case Report
Copyright ©The Author(s) 2005. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 14, 2005; 11(26): 4114-4116
Published online Jul 14, 2005. doi: 10.3748/wjg.v11.i26.4114
Acute exacerbation of autoimmune hepatitis induced by Twinrix
Antal Csepregi, Gerhard Treiber, Christoph Röcken, Peter Malfertheiner
Antal Csepregi, Gerhard Treiber, Christoph Röcken, Peter Malfertheiner, Department of Gastroenterology, Hepatology, and Infectious Diseases, Department of Pathology, Otto-von-Guericke University, Leipziger Str. 44, Magdeburg 39120, Germany
Author contributions: All authors contributed equally to the work.
Correspondence to: Antal Csepregi, MD, PhD, Department of Gastroenterology, Hepatology, and Infectious Diseases, Otto-von-Guericke University, Leipziger Str. 44, Magdeburg D-39120, Germany. csepregi.antal@medizin.uni-magdeburg.de
Telephone: +49-391-67-13-100 Fax: +49-391-67-13-105
Received: November 9, 2004
Revised: November 23, 2004
Accepted: November 29, 2004
Published online: July 14, 2005
Abstract

We report on a 26-year-old man who presented with severe jaundice and elevated serum liver enzyme activities after having received a dose of Twinrix® . In his past medical history, jaundice or abnormal liver function tests were never recorded. Following admission, an elevated immunoglobulin G level and antinuclear antibodies at a titer of 320 with a homogenous pattern were found. Histology of a liver biopsy showed marked bridging liver fibrosis and a chronic inflam-mation, compatible with autoimmune hepatitis. Treatment was started with budesonide and ursodeoxycholic acid, and led to complete normalization of the pathological liver function tests. We believe that Twinrix® led to an acute exacerbation of an unrecognized autoimmune hepatitis in our patient. The pathogenesis remains to be clarified. It is tempting to speculate that inactivated hepatitis A virus and/or recombinant surface antigen of the hepatitis B virus -as seen in patients with chronic hepatitis C and unrecognized autoimmune hepatitis who were treated with interferon alpha-might have been responsible for disease exacerbation.

Keywords: Twinrix®; Autoimmune hepatitis; Budesonide