Case Report
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World J Gastroenterol. Mar 21, 2013; 19(11): 1834-1840
Published online Mar 21, 2013. doi: 10.3748/wjg.v19.i11.1834
Case of autoimmune hepatitis with markedly enlarged hepatoduodenal ligament lymph nodes
Hideki Fujii, Naoki Ohnishi, Kazuho Shimura, Masafumi Sakamoto, Tohru Ohkawara, Yoshihiko Sawa, Koichi Nishida, Yasuo Ohkawara, Tatsuro Kobata, Kanji Yamaguchi, Yoshito Itoh
Hideki Fujii, Naoki Ohnishi, Kazuho Shimura, Masafumi Sakamoto, Tohru Ohkawara, Yoshihiko Sawa, Koichi Nishida, Yasuo Ohkawara, Department of Internal Medicine, Aiseikai Yamashina Hospital, Shichouno-cho, Takehana, Yamashina-ku, Kyoto 602-8086, Japan
Tatsuro Kobata, Department of Gastroenterology and Hepatology, Uji Tokushukai Hospital, Kyoto 611-0042, Japan
Kanji Yamaguchi, Yoshito Itoh, Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto 602-8566, Japan
Author contributions: Fujii H wrote the manuscript; Kobata T, Ohnishi N, Shimura K, Sakamoto M, Ohkawara T, Sawa Y, Nishida K, Ohkawara Y and Yamaguchi K took part in the discussion; Itoh Y designed the manuscript.
Correspondence to: Yoshito Itoh, MD, PhD, Associate Professor, Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kawaramachi-Hirokouji, Kamigyou-ku, Kyoto 602-8566, Japan. yitoh@koto.kpu-m.ac.jp
Telephone: +81-75-2515519 Fax: +81-75-2510710
Received: November 7, 2012
Revised: January 9, 2013
Accepted: January 23, 2013
Published online: March 21, 2013
Processing time: 134 Days and 22.3 Hours
Abstract

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.

Keywords: Autoimmune hepatitis; Humoral immune response; Hepatoduodenal ligament lymph nodes; Corticosteroid; Hepatomegaly