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A comparative study of uncomplicated acute non-A-E hepatitis with acute viral hepatitis and acute onset autoimmune hepatitis

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Abstract

Background and Aims

Non-A-E hepatitis (NAEH) not leading to acute liver failure (ALF) is poorly documented. The objective was to compare clinical and laboratory features of uncomplicated acute NAEH with acute viral (AVH) and autoimmune hepatitis (AIH) and histopathology in NAEH and AIH.

Methods

Cases of hepatocellular jaundice were included. These were grouped into AVH, AIH and NAEH based on clinical, laboratory and, when indicated, liver biopsy findings. NAEH and AIH were followed up at three months.

Results

Of 336 patients with hepatocellular jaundice, 15 (5%) were NAEH, 25 (7%) acute AIH and 45 (14%) AVH. Among NAEH patients, seven (46.7%) were males with a mean age of presentation 39 years. Jaundice (100%) was the most common presentation of NAEH. Peak bilirubin was 10.7 mg/dL. Peak aspartate and alanine aminotransferase (AST, ALT) were 512 and 670 U/L. Five (33.3%) patients had positive anti-nuclear antibody and one had anti-smooth muscle antibody. Mean immunoglobulin G (IgG) levels were 1829. On liver biopsy, all had ballooning degeneration, four (26.7%) had mild and three (20%) moderate interface hepatitis, four (26.7%) mild lymphoplasmacytic infiltrate, one (6.7%) rosette formation, bridging necrosis in none and stage 1 fibrosis in one. Comparing NAEH with AIH, AIH showed significantly older age at presentation, female predisposition, past history of jaundice, lower ALT, more autoantibodies, higher IgG, higher grade interface hepatitis, lymphoplasmacytic infiltrate, rosette formation and higher bilirubin, AST at three months. NAEH and viral hepatitis had similar features.

Conclusion

Etiology of NAEH is unlikely to be autoimmune and is probably viral, unidentified as yet. Uncomplicated NAEH likely has self-limiting course even without specific treatment.

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Data availability

The clinical data is available with the authors.

References

  1. Shalimar, Acharya SK, Kumar R, et al. Acute liver failure of non-A-E viral hepatitis etiology-profile, prognosis, and predictors of outcome. J Clin Exp Hepatol. 2020;10:453–61.

  2. Bernal W, Hyyrylainen A, Gera A, et al. Lessons from look-back in acute liver failure? A single centre experience of 3300 patients. J Hepatol. 2013;59:74–80.

    Article  PubMed  Google Scholar 

  3. Donaghy L, Barry FJ, Hunter JG, et al. Clinical and laboratory features and natural history of seronegative hepatitis in a nontransplant centre. Eur J Gastroenterol Hepatol. 2013;25:1159–64.

    CAS  PubMed  Google Scholar 

  4. Ben-Ari Z, Samuel D, Zemel R, et al. Fulminant non-A-G viral hepatitis leading to liver transplantation. Arch Intern Med. 2000;160:388–92.

    Article  CAS  PubMed  Google Scholar 

  5. Brennan PN, Donnelly MC, Simpson KJ. Systematic review: non A-E, seronegative or indeterminate hepatitis; what is this deadly disease? Aliment Pharmacol Ther. 2018;47:1079–91.

    Article  CAS  PubMed  Google Scholar 

  6. Tokumoto Y, Onji M. Acute-onset autoimmune hepatitis. Intern Med. 2007;46:1–2.

    Article  PubMed  Google Scholar 

  7. Miyake Y, Iwasaki Y, Kobashi H, et al. Autoimmune hepatitis with acute presentation in Japan. Dig Liver Dis. 2010;42:51–4.

    Article  CAS  PubMed  Google Scholar 

  8. Muratori P, Carbone M, Stangos G, et al. Clinical and prognostic implications of acute onset of autoimmune hepatitis: an Italian multicentre study. Dig Liver Dis. 2018;50:698–702.

    Article  PubMed  Google Scholar 

  9. Aljumah AA, Al-Ashgar H, Fallatah H, Albenmousa A. Acute onset autoimmune hepatitis: clinical presentation and treatment outcomes. Ann Hepatol. 2019;18:439–44.

    Article  PubMed  Google Scholar 

  10. Schaefer TJ, John S. Acute Hepatitis. [Updated 2020 October 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021. Available from: https://www.ncbi.nlm.nih.gov/books/NBK551570/.

  11. Lanini S, Ustianowski A, Pisapia R, Zumla A, Ippolito G. Viral hepatitis: etiology, epidemiology, transmission, diagnostics, treatment, and prevention. Infect Dis Clin North Am. 2019;33:1045–62.

    Article  PubMed  Google Scholar 

  12. Bunchorntavakul C, Reddy KR. Epstein-Barr virus and cytomegalovirus infections of the liver. Gastroenterol Clin North Am. 2020;49:331–46.

    Article  PubMed  Google Scholar 

  13. Then EO, Gayam V, Are VS, Sunkara T, Gaduputi V. Herpes simplex virus hepatitis: a brief review of an Oft-overlooked pathology. Cureus. 2019;11:e4313.

    PubMed  PubMed Central  Google Scholar 

  14. Zhang C, Shi L, Wang FS. Liver injury in COVID-19: management and challenges. Lancet Gastroenterol Hepatol. 2020;5:428–30.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Sarin SK, Choudhury A, Sharma MK, et al. APASL ACLF Research Consortium (AARC) for APASL ACLF working Party. Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL): an update. Hepatol Int. 2019;13:353–90.

    Article  PubMed  Google Scholar 

  16. Crabb DW, Im GY, Szabo G, Mellinger JL, Lucey MR. Diagnosis and treatment of alcohol-associated liver diseases: 2019 practice guidance from the American Association for the Study of Liver Diseases. Hepatology. 2020;71:306–33.

    Article  PubMed  Google Scholar 

  17. Terrault NA, Lok ASF, McMahon BJ, et al. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatology. 2018;67:1560–99.

    Article  PubMed  Google Scholar 

  18. Mack CL, Adams D, Assis DN, et al. Diagnosis and management of autoimmune hepatitis in adults and children: 2019 practice guidance and guidelines from the American Association for the Study of Liver Diseases. Hepatology. 2020;72:671–722.

    Article  PubMed  Google Scholar 

  19. Ganger DR, Rule J, Rakela J, et al. Acute Liver Failure Study Group. Acute liver failure of indeterminate etiology: a comprehensive systematic approach by an expert committee to establish causality. Am J Gastroenterol. 2018;113:1319.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Alter MJ, Gallagher M, Morris TT, et al. Acute non-A-E hepatitis in the United States and the role of hepatitis G virus infection. Sentinel Counties Viral Hepatitis Study Team. N Engl J Med. 1997;336:741–6.

    Article  CAS  PubMed  Google Scholar 

  21. Delić D, Mitrović N, Spurnić AR, Svirtlih NS, Babić JS. Epidemiological characteristics and clinical manifestations of acute non-A-E hepatitis. Vojnosanit Pregl. 2010;67:903–9.

    Article  PubMed  Google Scholar 

  22. Paraná R, Codes L, Andrade Z, et al. Clinical, histologic and serologic evaluation of patients with acute non-A-E hepatitis in north-eastern Brazil: is it an infectious disease? Int J Infect Dis. 2003;7:222–30.

    Article  PubMed  Google Scholar 

  23. Nagral N, Joshi V, Baria K, et al. Prevalence of non A to E hepatitis in Mumbai, India. Rev Gastroenterol Peru. 2018;38:49–53.

    PubMed  Google Scholar 

  24. Geller SA. Autoimmune hepatitis: histopathology. Clin Liver Dis (Hoboken). 2014;3:19–23.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Sonthalia N, Rathi PM, Jain SS, et al. Natural history and treatment outcomes of severe autoimmune hepatitis. J Clin Gastroenterol. 2017;51:548–56.

    Article  PubMed  Google Scholar 

  26. Abutaleb A, Kottilil S. Hepatitis A: epidemiology, natural history, unusual clinical manifestations, and prevention. Gastroenterol Clin North Am. 2020;49:191–9.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Aggarwal R. Hepatitis E: epidemiology and natural history. J Clin Exp Hepatol. 2013;3:125–33.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Menzo S, Minosse C, Vincenti D, et al. Long-term follow-up of acute hepatitis B: new insights in its natural history and implications for antiviral treatment. Genes (Basel). 2018;9:293.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Borse NC, Rathi PM, Sawant P. Hepatitis G virus: an innocent contaminant. J Assoc Physicians India. 1999;47:721–3.

    CAS  PubMed  Google Scholar 

  30. Tassopoulos NC, Papatheodoridis GV, Delladetsima I, Hatzakis A. Clinicopathological features and natural history of acute sporadic non-(A-E) hepatitis. J Gastroenterol Hepatol. 2008;23 8 Pt 1:1208–15.

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Funding

Departmental development fund of Department of Gastroenterology, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Mumbai

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Authors and Affiliations

  1. Department of Gastroenterology, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Room No.717, 7th Floor, OPD Building, Mumbai, 400 008, India

    Siddhesh Vijay Rane, Shubham Jain, Partha Debnath, Rahul Deshmukh, Sujit Nair, Sanjay Chandnani, Rima Kamat & Pravin Rathi

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  1. Siddhesh Vijay Rane
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Contributions

Concepts: SVR, SJ, PD, RD, SN, SC, RK, PR; design: SVR, SJ, PD, RD, SN, SC, RK, PR; definition of intellectual content: SVR, SJ, PD, RD, SN, SC, RK, PR; literature search: SVR, SJ, PD, RD; clinical studies: SVR, SJ, PD, RD, PR; data acquisition: SVR, SJ; data analysis: SVR, SJ, PD, RD, SN, SC; statistical analysis: SVR, SJ, PD, SN, SC; histological analysis: RK; manuscript preparation: SVR, SJ; manuscript editing: SVR, SJ, SN; manuscript review: SC, PR.

Corresponding author

Correspondence to Siddhesh Vijay Rane.

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Competing interests

SVR, SJ, PD, RD, SN, SC, RK and PR declare no competing interests.

Ethics statement

The study was performed conforming to the Helsinki Declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on Springer.com.

Ethical approval

Ethical approval was obtained from ethics committee (ECARP/2019/68) and patient consent was taken for participation in the study.

Human ethics

The study was conducted in compliance with the declaration of Helsinki.

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Consent for publication was obtained from patients at the time of enrolment in the study.

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Rane, S.V., Jain, S., Debnath, P. et al. A comparative study of uncomplicated acute non-A-E hepatitis with acute viral hepatitis and acute onset autoimmune hepatitis. Indian J Gastroenterol 43, 443–451 (2024). https://doi.org/10.1007/s12664-023-01474-1

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