Is simultaneous presence of IgG4-positive plasma cells and giant-cell hepatitis a coincidence in autoimmune hepatitis? A case report

Abstract

BACKGROUND

The immune-mediated invasion of IgG4-positive plasma cells in the liver is found in some autoimmune hepatitis. Giant-cell hepatitis (GCH) is a very rare pathological feature in adults, and the clinical characteristics of the simultaneous appearance of the two pathological phenomena are not clear.

CASE SUMMARY

A 68-year-old woman was hospitalized with fatigue, poor appetite, and yellow urine for 20 d. Liver function tests and immunological indexes were significantly abnormal and accompanied by elevated serum IgG4 levels. Liver pathology revealed severe inflammation of the interface between the portal tract and hepatocytes, portal area inflammation, plasma cell infiltration, formation of rosette cells, IgG4-positive plasma cells > 10/high-power field, IgG4/IgG > 40%, and multinucleated liver cell swelling. IgG4-related autoimmune hepatitis (AIH) combined with GCH was diagnosed, and methylprednisolone was administered at 40 mg/day. Two weeks later, the clinical symptoms disappeared, and the liver function and immunological indicators were significantly improved. Methylprednisolone was reduced at a rate of 4–8 mg per week to 8 mg/day for maintenance. A second liver biopsy 48 wk later indicated that liver inflammation and fibrosis were significantly improved. IgG4-positive plasma cells and GCH were not detected. A literature search was conducted to analyze articles reporting similar pathological phenomena.

CONCLUSION

AIH with simultaneous IgG4-positive plasma cell infiltration and GCH, liver inflammation, and fibrosis is possibly more severe than typical AIH but sensitive to corticosteroids.

Keywords: IgG4; Autoimmune hepatitis; Giant-cell hepatitis; Case report

Core Tip: A 68-year-old woman was hospitalized for liver function tests. Her immunological indices differed significantly from normal, and were accompanied by elevated serum IgG4 levels. Liver pathology revealed severe inflammation at the interface between the portal tract and hepatocytes, plasma cell infiltration, formation of rosette cells, IgG4-positive plasma cells > 10/high-power field, IgG4/IgG > 40%, and multinucleated liver cell swelling. The patient was diagnosed as having IgG4-autoimmune hepatitis combined with giant-cell hepatitis (GCH), and 40 mg/day methylprednisolone was administered. A second liver biopsy 48 wk later indicated significant amelioration of liver inflammation and fibrosis. IgG4-positive plasma cells and GCHs were not detected. A literature search was conducted to analyze reports of similar pathological phenomena.