Hepatitis A virus-induced autoimmune hepatitis: A case-based review

Figure 1 Aminotransferases activity. A: Aminotransferases activity during the patient’s initial hospitalization; B: Aminotransferases activity during the patient’s second hospitalization. ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; U/L: Units per liter.

Figure 2 Pathologic findings of the liver biopsy. A: The portal tracts are infiltrated by lymphocytes, plasma cells and eosinophils. The interface hepatitis is evident; B: Close-up view to portal tract with interface hepatitis and parenchymal hepatitis with the contribution of eosinophils and plasma cells.

Figure 3 A double chromogen assay of immunohistochemistry for CD4 (3,3’-diaminobenzidine, brown colour) and CD8 (red colour). Close to equal contribution of CD4 and CD8 lymphocytes. Numerous CD8+ cytotoxic lymphocytes in the portal tract.

Figure 4 CD138-positive singular and aggregates plasma cells in the portal tract (immunohistochemistry, CD138).

Figure 5 Aminotransferases activity during the nine-month follow-up period and corresponding treatment. ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; U/L: Units per liter.

Figure 6 Simplified algorithm of first-line and subsequent therapeutic management in autoimmune hepatitis (according to European Association for the Study of the Liver Clinical Practice Guidelines, 2025). ¹Low-dose predniso(lo)ne monotherapy can be suggested only in patients with mild disease who achieved complete biochemical response and are intolerant to both azathioprine and mycophenolate mofetil. AZP: Azathioprine; MMF: Mycophenolate mofetil; CBR: Complete biochemical response; TG: Thioguanine; TGN: Thioguanine nucleotides; MMP: Methylmercaptopurine.