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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)
Liver disease
Published in Catherine Nelson-Piercy, Handbook of Obstetric Medicine, 2020
To exclude other common causes of pruritus and abnormal liver function, the following investigations are recommended: Liver US (the presence of gallstones without evidence of extra-hepatic obstruction does not exclude a diagnosis of ICP). Gallstones are found more commonly in women with ICP.Viral serology (for hepatitis B and C). If there are clinical features of acute hepatitis, then hepatitis A virus, HEV, EBV and CMV are also indicated.Liver autoantibodies (for pre-existing liver disease; anti-smooth muscle antibody/chronic active hepatitis [CAH]; anti-mitochondrial antibodies/primary biliary cirrhosis [PBC]) should only be requested if abnormal LFTs preceded the pregnancy, if there are other features of pre-existing liver disease or if LFTs do not normalize post-delivery.
Diagnostic Approach to Fulminant Hepatitis in the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
Autoimmune hepatitis (AIH) can present acutely as a spontaneous flare of a pre-existing chronic disease, acute disease, chronic disease with superimposed acute injury, or after treatment of a pre-existing liver disease with immunomodulators and liver transplantation. Acute presentations of AIH account for 25% of all cases and may be confused with acute viral disease [47]. The clinical presentation of acute AIH is indistinguishable from that of other acute viral hepatitides and requires specific antibody testing for accurate diagnosis. Autoimmune hepatitis is more common in women than in men, and there may be a history of significant childhood acne, hirsutism, and amenorrhea [48]. On acute presentation, as many as 50% may already have cirrhosis. The diagnosis of acute AIH is made by a combination of elevated serum globulins, predominantly serum IgG, and a positive anti-smooth muscle antibody with or without a positive antinuclear antibody. Liver biopsy typically will reveal plasma cells, rosette formation with or without the presence of fibrosis, or cirrhosis. Acute AIH is treated with either oral or intravenous steroids [47].
The onset of de novo autoantibodies in healthcare workers after mRNA based anti-SARS-CoV-2 vaccines: a single centre prospective follow-up study
Published in Autoimmunity, 2023
M.C Sacchi, C. Pelazza, M. Bertolotti, L. Agatea, P. De Gaspari, S. Tamiazzo, D. Ielo, P. Stobbione, M. Grappiolo, T. Bolgeo, P. Novel, M.M Ciriello, A. Maconi
All samples were analysed for the presence of a) antinuclear antibodies (ANA) using indirect Immunofluorescence [IIF] on the substrate Hep-2 EUROIMMUN; (dilutions of 1:80, 1:160. 1:320 and 1:640), and anti-smooth muscle antibodies (ASMA 1:80, 1;160) (IIF, Euroimmun); b) anti-myeloperoxidase (anti-MPO), anti-proteinase 3 (anti-PR3) and anti-citrullinated peptide antibodies (aCCP) ([FEIA], Thermo Fisher Scientific); c) anti-phospholipid antibodies (anticardiolipin [aCL], anti-beta-2- glycoprotein I [anti-ß-2GPI] (Chemiluminescence, Werfen). d) Line-blot technology was performed using the following kit: EUROLINE ANA profile 3 plus DFS70 (IgG). The test is specific for the following antigens: nRNP/Sm, Sm, SS-A, Ro-52, SS-B, Scl-70, PM-Scl, Jo-1, CENP B, PCNA, dsDNA, nucleosomes, histones, Protein P ribosomal, AMA-M2, DFS70. e) Anti-RF was measured using a fully automated spectrophotometric/immunoturbidimetric and ion selective electrode measurement system (Advia XPT analyser; Siemens).
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.