Autoimmune hepatitis and primary sclerosing cholangitis after direct-acting antiviral treatment for hepatitis C virus: A case report

Table 1 Blood test

Blood test	Value	Unit
Hematology
WBC	59.00	× 102/μL
RBC	400.00	× 104/μL
Hb	12.30	g/dL
Ht	37.30	%
PLT	13.30	× 104/μL
PT (%)	81.90	%
Serum chemistry
TP	9.70	g/dL
ALB	3.60	g/dL
T-Bil	1.00	mg/dL
AST	418.00	U/L
ALT	366.00	U/L
ALP	371.00	U/L
γ-GT	102.00	U/L
LD	388.00	U/L
BUN	13.40	mg/dL
Cre	0.65	mg/dL
CRP	0.02	mg/dL
IgA	605.00	mg/dL
IgM	795.00	mg/dL
IgG	3481.00	mg/dL
ANA	80
ASMA	640
AMA	< 20
HAV-IgM	Negative
HEV-IgA	Negative
HBs-Ag	Negative
HBs-Ab	Negative
HBc-Ab	Positive
HBV-DNA	< 2.1	Logcopy/mL
HCV-Ab	Positive
HCV-RNA	< 1.2	LogIU/mL
CMV-IgM	Negative
CMV-IgG	Positive
VCA-IgM	Negative
VCA-IgG	Positive
EBNA	Positive
HLA	DR4

WBC: White blood cell; RBC: Red blood cell; Hb: Hemoglobin; Ht: Hematocrit; PLT: Platelet; PT: Prothrombin time; TP: Total protein; ALB: Albumin; T-Bil: Total-bilirubin; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; ALP: Alkaline phosphatase; γ-GT: γ-Glutamyl transpeptidase; LD: Lactate dehydrogenase; BUN: Blood urea nitrogen; CRP: C reactive protein; ANA: Antinuclear antibody; ASMA: Antismooth muscle antibody; AMA: Antimitochondrial antibody; HAV: Hepatitis A virus; HEV: Hepatitis E virus; VCA: Viral capsid antigen; HCV: Hepatitis C virus; EBNA: Epstein-Barr virus nuclear antigen; HLA: Human leukocyte antigen.

Table 2 Blood test results (antinuclear antibody and antismooth muscle antibody)

Blood test	ANA	ASMA
Before DAAs (SOF/LDV) therapy	< 20	< 20
After DAAs (SOF/LDV) therapy	40	20
SVR 12	40	160
SVR 24	80	640

ANA: Antinuclear antibody; ASMA: Antismooth muscle antibody; DAA: Direct antiviral agent; SOF: Sofosbuvir; LDV: Ledipasvir; SVR: Sustained virological response.

Table 3 Four cases of autoimmune hepatitis development following direct antiviral agent treatment

Ref.	Age	Sex	HLA-DR4	Autoimmune disease	Genotype	DAA	Onset	Treatment	Follow up
Matsumoto et al[29], 2018	81	Female	Negative	None	1 (serotype)	EBR/GZR	2 months	PSL	Improvement
Covini et al[31], 2018	72	Female	NA	ITP	1b	SOF/LDV	2 wk	PSL	Improvement
Montón et al[30], 2020	72	Female	NA	None	1b	SOF/LDV	3 yr	PSL	Improvement
Our case	80	Female	Positive	None	1b	SOF/LDV	9 months	PSL + UDCA	Development of PSC

DAA: Direct antiviral agent; EBR/GZR: Elbasvir/Grazoprevir; HLA: Human leukocyte antigen; ITP: Idiopathic thrombocytopenic purpura; PSC: Primary sclerosing cholangitis; PSL: Prednisolone; SOF/LDV: Sofosbuvir/Ledipasvir; UDCA: Ursodeoxycholic acid.