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Histological improvement in chronic hepatitis C-autoimmune hepatitis overlap syndrome by glecaprevir and pibrentasvir

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Abstract

A 60-year-old man with type-2 diabetes and chronic hepatitis C (HCV) was diagnosed with single hepatocellular carcinoma (HCC) of 67 mm in the hepatic posterior right lobe. Lenvatinib 8 mg was initiated but discontinued because of grade 3 liver injury. The patient continued to have prolonged liver injury and persistently high immunoglobulin G levels. Antinuclear antibody titer increased from 1:40 to 1:320. Histopathological examination of a liver biopsy specimen revealed interface hepatitis with lymphocyte and plasma cell infiltration, rosette formation, and emperipolesis, suggesting the possibility of autoimmune hepatitis (AIH). First, treatment with prednisolone was initiated; however, the response was poor. After starting glecaprevir/pibrentasvir (GLE/PIB) as direct-acting antivirals (DAA), HCV RNA rapidly disappeared, and serological liver function improved. After confirmation of sustained virological response 24, HCC recurrence was observed, and partial hepatectomy was performed. Background liver findings showed that liver parenchymal inflammation improved compared with that before DAA treatment. This is the first case of HCV-AIH overlap syndrome treated with DAA using GLE/PIB. Liver function improved within a short treatment period of 8 weeks, as confirmed using serology and histology.

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Acknowledgements

We would like to thank Editage (http://www.editage.jp) for English language editing.

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Authors and Affiliations

  1. Department of Gastroenterology, Teikyo University Mizonokuchi Hospital, 5-1-1 Futago, Takatsu-Ku, Kawasaki, 213-8507, Japan

    Kotaro Matsumoto, Yuta Namura, Ayako Watanabe, Hiromichi Tsunashima & Shinpei Doi

  2. Fourth Department of Internal Medicine, Teikyo University Mizonokuchi Hospital, Kawasaki, Japan

    Kentaro Kikuchi

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  1. Kotaro Matsumoto
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  5. Hiromichi Tsunashima
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  6. Shinpei Doi
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by KM. The first draft of the manuscript was written by KM, KK, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Kotaro Matsumoto.

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Matsumoto, K., Kikuchi, K., Namura, Y. et al. Histological improvement in chronic hepatitis C-autoimmune hepatitis overlap syndrome by glecaprevir and pibrentasvir. Clin J Gastroenterol 16, 572–579 (2023). https://doi.org/10.1007/s12328-023-01809-7

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  • DOI: https://doi.org/10.1007/s12328-023-01809-7

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