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Liver, Biliary Tract and Pancreatic Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Autoantibodies may help in the diagnosis of liver disease; titres >1 : 100 are usually significant. Antinuclear antibodies (ANA): associated with autoimmune hepatitisAntimitochondrial antibodies (AMA): diagnostic of PBCAntiliver/kidney microsomal antibodies: associated with some forms of autoimmune hepatitis and drug-induced liver injury (DILI)Antineutrophil cytoplasmic antibodies (ANCAs): have been associated with primary sclerosing cholangitis (PSC)Anti-smooth muscle antibody (ASMA): may be found in autoimmune hepatitis but also in PBC, HCV infection and some cancers (e.g. melanoma and breast cancer)
Cirrhosis
Published in Louisa Baxter, Neel Sharma, Ian Mann, The Junior Doctor’s Guide to Gastroenterology, 2018
Louisa Baxter, Neel Sharma, Ian Mann, Ian Sanderson
Autoantibody screen. This should include anti-mitochondrial antibody (AMA), anti-smooth muscle antibody (ASMA) and antinuclear antibody (ANA). The AMA level is elevated in more than 95% of patients with primary biliary cirrhosis (PBC).
Case 44: An Elderly Woman with Painless Jaundice
Published in Layne Kerry, Janice Rymer, 100 Diagnostic Dilemmas in Clinical Medicine, 2017
The patient appears to be relatively stable despite her deteriorating liver function. An urgent liver screen should be arranged, including serology for hepatitis viruses, CMV, EBV and HIV. Alpha-fetoprotein, a hepatocellular carcinoma and germ cell tumour marker, should also be measured. Given the patient's age, it would not be appropriate to send a serum caeruloplasmin level to be tested – symptoms of Wilson's disease usually present in childhood or early adulthood. An autoantibody screen (anti-mitochondrial antibody, anti-smooth muscle antibody and anti-nuclear antibody) will also need to be sent.
Selection of abstracts from Baylor Scott & White Health Central Texas Scholars Day
Published in Baylor University Medical Center Proceedings, 2022
Angela D. Rutherford, Wendy Hegefeld, William Culp, Patrick Lowry, Hania Janek, Shekhar Ghamande, Megan Newman, Austin Metting, J. Scott Thomas, V. Maxanne Flores, Niraj Vora, Christian Cable
A 62-year-old Caucasian woman with a history of remote breast cancer and hypertension presented with jaundice, elevated transaminase levels, skin changes, abdominal tightness, fatigue, and lower extremity swelling. She had a history of consuming 3 to 8 beers daily and taking multiple unspecified supplements advertised to prevent infection with COVID-19. She had no drug use or family history of liver disease. The exam was notable for jaundice with scleral icterus, abdominal distention, and lower extremity edema. Laboratory tests were notable for a sodium level of 125 mEq/L, aspartate transaminase of 2003 U/L, alanine aminotransferase of 1032 U/L, total bilirubin of 15 umol/L, alkaline phosphatase of 406 IU/L, and international normalized ratio of 3.0. Ultrasound showed a cirrhotic-appearing liver. She was given N-acetyl cysteine and vitamin K and discharged with improvement in liver function tests. At follow-up, antinuclear antibodies and anti-SSA were positive and anti-smooth muscle antibody was negative. Liver biopsy showed massive necrotic changes and aggregates of plasma cells suggestive of an autoimmune etiology. Despite steroid initiation, her hepatic synthetic and kidney function declined. She was transferred and underwent orthotopic liver transplantation successfully. This case brings attention to a potentially manageable condition. With early identification and awareness of autoimmune hepatitis, including seronegative patients, practitioners will be well equipped to provide care that could prevent disease escalation, reduce the need for invasive procedures, and potentially improve quality of life.
Systemic lupus erythematosus triggered by trimethoprim–sulfamethoxazole
Published in Scandinavian Journal of Rheumatology, 2020
A few months after she had permanently discontinued TMP-SMX, she redeveloped arthritis in the same joints with stiffness lasting for a few hours. An ANA profile was again checked, which was now remarkably positive for anti-RNP, anti-Smith, anti-histone, and anti-double-stranded DNA (anti-dsDNA) antibodies. The patient also had hypocomplementaemia along with persistently elevated inflammatory markers. Her ANA titre had now increased to 1:>10 240. Low-dose prednisone was initiated with limited effect. The patient ultimately required admission owing to symptom progression, manifesting a malar rash, alopecia, oral ulcers, recurrent fevers, anaemia, leucopenia, elevated liver enzymes, pleuritic chest pain, and blurry vision with floaters. Ophthalmological exam revealed Purtscher’s-like retinopathy. Anti-smooth muscle antibody testing returned positive. Head imaging was negative for central nervous system involvement. Urinalysis and urine protein-to-creatinine (Pr:Cr) ratio were both normal. She was given intravenous pulse steroids and subsequently switched to high-dose oral prednisone, with beneficial results.
Assessment of the Prevalence of Non-Organ-Specific Autoantibodies in Egyptian Patients with HCV
Published in Immunological Investigations, 2020
Mohamed Emara, Esraa Mohsen, Riham M. Shawky, Ramadan A. El-Domany
The immune system is an orchestration of cellular and molecular elements that work together to protect the body against attack. Under normal conditions, the immune system exhibits tolerance (a diverse range of host processes that prevent potentially harmful immune responses within that host) (Waldmann 2014) to its molecules/antigens (self-antigens) as carbohydrates, nucleic acids, or proteins that are usually expressed in endogenous tissues. The breaking of immune system self-tolerance results in attack of the body‘s own molecules through the action of autoantibodies that target auto-antigens (autoimmunity) (Kaur et al. 2017). The prevalence of circulating autoantibodies has been shown to be high in patients with chronic HCV infection. Circulating autoantibodies as antinuclear antibodies (ANAs), rheumatoid factor (RF-IgG), anti-phospholipid (aPL) antibodies, cryo-globulins, and anti-smooth muscle antibodies (ASMA) are often detected in patients with chronic HCV infection (Ramos-Casals et al. 2009).