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{{Autoimmune hepatitis}}
{{Autoimmune hepatitis}}
{{CMG}}; {{AE}} :{{MKK}}
{{CMG}}; {{AE}}:{{MKK}}


==Overview==
==Overview==
The majority of patients with [disease name] are asymptomatic.
Patient with [[autoimmune hepatitis]] presents asymptomatic or with symptoms of [[acute liver failure]]. A positive history of [[viral infections]] like [[hepatitis A]], C, and drug intake like [[minocycline]], [[interferon]] α, [[nitrofurantoin]], [[infliximab]], [[ezetimibe]], [[interferon]] β, [[ornidazole]], [[diclofenac]], [[indomethacin]], [[terbinafine]], [[methyldopa]], [[ranitidine]], [[atorvastatin]], [[fluvastatin]], [[fibrates]], [[adalimumab]] is suggestive of [[autoimmune hepatitis]]. The common symptoms of autoimmune hepatitis include [[jaundice]], [[fatigue]], and [[abdominal discomfort]]. Less common symptoms of autoimmune hepatitis include [[acne]], [[edema]], [[hirsutism]], [[amenorrhea]].
 
OR
 
The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].


==History==
==History==
*The majority of patients with Autoimmune hepatitis are asymptomatic leads to severe symptoms and progresses even to fulminant hepatitis.
*The majority of patients with [[autoimmune hepatitis]] are initially asymptomatic but leads to severe symptoms and progresses even to [[fulminant hepatitis]].
*Autoimmune hepatitis can present as acute hepatitis, chronic hepatitis, or well-established cirrhosis. Autoimmune hepatitis can rarely present as the fulminant hepatic failure.
*Autoimmune hepatitis can present as acute [[hepatitis]], [[chronic hepatitis]], or well-established [[cirrhosis]]. Autoimmune hepatitis can rarely present as the [[fulminant hepatic failure]].  
*The hallmark of Autoimmune hepatitis is fatigue and jaundice.
*The hallmark of autoimmune hepatitis is [[fatigue]] and [[jaundice]].
*A positive history of fatigue and jaundice is suggestive of Autoimmune hepatitis.
 
==History ==
Obtaining the history is the most important aspect of making a [[diagnosis]] of Autoimmune hepatitis. It provides insight into the [[Causality|cause]], precipitating factors and associated autoimmune conditions.
 
===Past Medical History===
===Past Medical History===
*History of hepatitis A, hepatitis E, cytomegalovirus and Epstein–Barr virus.<ref name="pmid15888974">{{cite journal |vauthors=Nagasaki F, Ueno Y, Mano Y, Igarashi T, Yahagi K, Niitsuma H, Okamoto H, Shimosegawa T |title=A patient with clinical features of acute hepatitis E viral infection and autoimmune hepatitis |journal=Tohoku J. Exp. Med. |volume=206 |issue=2 |pages=173–9 |year=2005 |pmid=15888974 |doi= |url=}}</ref><ref name="pmid11446931">{{cite journal |vauthors=Castellote J, Güell E, Porta F |title=[Autoimmune hepatitis following cytomegalovirus infection] |language=Spanish; Castilian |journal=Med Clin (Barc) |volume=117 |issue=2 |pages=76 |year=2001 |pmid=11446931 |doi= |url=}}</ref><ref name="pmid9219819">{{cite journal |vauthors=Kamisako T, Tsubaki K, Adachi Y, Kamisato T |title=Autoimmune hepatitis after cytomegalovirus infection in a bone marrow-transplanted patient |journal=Am. J. Gastroenterol. |volume=92 |issue=7 |pages=1238–9 |year=1997 |pmid=9219819 |doi= |url=}}</ref><ref name="pmid7499793">{{cite journal |vauthors=Huppertz HI, Treichel U, Gassel AM, Jeschke R, Meyer zum Büschenfelde KH |title=Autoimmune hepatitis following hepatitis A virus infection |journal=J. Hepatol. |volume=23 |issue=2 |pages=204–8 |year=1995 |pmid=7499793 |doi= |url=}}</ref><ref name="pmid14871651">{{cite journal |vauthors=Vento S, Cainelli F |title=Is there a role for viruses in triggering autoimmune hepatitis? |journal=Autoimmun Rev |volume=3 |issue=1 |pages=61–9 |year=2004 |pmid=14871651 |doi=10.1016/S1568-9972(03)00053-3 |url=}}</ref>
*History of [[hepatitis]] A, hepatitis E, [[cytomegalovirus]], and [[Epstein Barr virus|Epstein–Barr virus]].
*History of hepatitis A vaccination.
*History of hepatitis A vaccination.<ref name="pmid15888974">{{cite journal |vauthors=Nagasaki F, Ueno Y, Mano Y, Igarashi T, Yahagi K, Niitsuma H, Okamoto H, Shimosegawa T |title=A patient with clinical features of acute hepatitis E viral infection and autoimmune hepatitis |journal=Tohoku J. Exp. Med. |volume=206 |issue=2 |pages=173–9 |year=2005 |pmid=15888974 |doi= |url=}}</ref><ref name="pmid11446931">{{cite journal |vauthors=Castellote J, Güell E, Porta F |title=[Autoimmune hepatitis following cytomegalovirus infection] |language=Spanish; Castilian |journal=Med Clin (Barc) |volume=117 |issue=2 |pages=76 |year=2001 |pmid=11446931 |doi= |url=}}</ref><ref name="pmid9219819">{{cite journal |vauthors=Kamisako T, Tsubaki K, Adachi Y, Kamisato T |title=Autoimmune hepatitis after cytomegalovirus infection in a bone marrow-transplanted patient |journal=Am. J. Gastroenterol. |volume=92 |issue=7 |pages=1238–9 |year=1997 |pmid=9219819 |doi= |url=}}</ref><ref name="pmid7499793">{{cite journal |vauthors=Huppertz HI, Treichel U, Gassel AM, Jeschke R, Meyer zum Büschenfelde KH |title=Autoimmune hepatitis following hepatitis A virus infection |journal=J. Hepatol. |volume=23 |issue=2 |pages=204–8 |year=1995 |pmid=7499793 |doi= |url=}}</ref><ref name="pmid14871651">{{cite journal |vauthors=Vento S, Cainelli F |title=Is there a role for viruses in triggering autoimmune hepatitis? |journal=Autoimmun Rev |volume=3 |issue=1 |pages=61–9 |year=2004 |pmid=14871651 |doi=10.1016/S1568-9972(03)00053-3 |url=}}</ref>
 
===Medication History===
===Medication History===
*Prior use of minocycline, interferon α, nitrofurantoin and, infliximab, ezetimibe, interferon β, ornidazole, diclofenac, indomethacin, terbinafine, methyldopa, ranitidine, atorvastatin, fluvastatin, fibrates, adalimumab increases the risk of autoimmune hepatitis.<ref name="pmid21757447">{{cite journal |vauthors=Gleeson D, Heneghan MA |title=British Society of Gastroenterology (BSG) guidelines for management of autoimmune hepatitis |journal=Gut |volume=60 |issue=12 |pages=1611–29 |year=2011 |pmid=21757447 |doi=10.1136/gut.2010.235259 |url=}}</ref><ref name="pmid10852297">{{cite journal |vauthors=Colmegna I, Perandones CE, Chaves JG |title=Minocycline induced lupus and autoimmune hepatitis |journal=J. Rheumatol. |volume=27 |issue=6 |pages=1567–8 |year=2000 |pmid=10852297 |doi= |url=}}</ref><ref name="pmid7539390">{{cite journal |vauthors=Heathcote EJ |title=Autoimmune hepatitis and chronic hepatitis C: latent or initiated by interferon therapy? |journal=Gastroenterology |volume=108 |issue=6 |pages=1942–4 |year=1995 |pmid=7539390 |doi= |url=}}</ref><ref name="pmid16162908">{{cite journal |vauthors=Germano V, Picchianti Diamanti A, Baccano G, Natale E, Onetti Muda A, Priori R, Valesini G |title=Autoimmune hepatitis associated with infliximab in a patient with psoriatic arthritis |journal=Ann. Rheum. Dis. |volume=64 |issue=10 |pages=1519–20 |year=2005 |pmid=16162908 |pmc=1755231 |doi=10.1136/ard.2004.032821 |url=}}</ref><ref name="pmid11026106">{{cite journal |vauthors=Goldstein NS, Bayati N, Silverman AL, Gordon SC |title=Minocycline as a cause of drug-induced autoimmune hepatitis. Report of four cases and comparison with autoimmune hepatitis |journal=Am. J. Clin. Pathol. |volume=114 |issue=4 |pages=591–8 |year=2000 |pmid=11026106 |doi=10.1309/KV2J-VX6Q-L95V-VDE4 |url=}}</ref>
*Prior use of [[minocycline]], [[interferon]] α, [[nitrofurantoin]], [[infliximab]], [[ezetimibe]], [[interferon]] β, [[ornidazole]], [[diclofenac]], [[indomethacin]], [[terbinafine]], [[methyldopa]], [[ranitidine]], [[atorvastatin]], [[fluvastatin]], [[fibrates]], [[adalimumab]]  increases the risk of autoimmune hepatitis.<ref name="pmid21757447">{{cite journal |vauthors=Gleeson D, Heneghan MA |title=British Society of Gastroenterology (BSG) guidelines for management of autoimmune hepatitis |journal=Gut |volume=60 |issue=12 |pages=1611–29 |year=2011 |pmid=21757447 |doi=10.1136/gut.2010.235259 |url=}}</ref><ref name="pmid10852297">{{cite journal |vauthors=Colmegna I, Perandones CE, Chaves JG |title=Minocycline induced lupus and autoimmune hepatitis |journal=J. Rheumatol. |volume=27 |issue=6 |pages=1567–8 |year=2000 |pmid=10852297 |doi= |url=}}</ref><ref name="pmid7539390">{{cite journal |vauthors=Heathcote EJ |title=Autoimmune hepatitis and chronic hepatitis C: latent or initiated by interferon therapy? |journal=Gastroenterology |volume=108 |issue=6 |pages=1942–4 |year=1995 |pmid=7539390 |doi= |url=}}</ref><ref name="pmid16162908">{{cite journal |vauthors=Germano V, Picchianti Diamanti A, Baccano G, Natale E, Onetti Muda A, Priori R, Valesini G |title=Autoimmune hepatitis associated with infliximab in a patient with psoriatic arthritis |journal=Ann. Rheum. Dis. |volume=64 |issue=10 |pages=1519–20 |year=2005 |pmid=16162908 |pmc=1755231 |doi=10.1136/ard.2004.032821 |url=}}</ref><ref name="pmid11026106">{{cite journal |vauthors=Goldstein NS, Bayati N, Silverman AL, Gordon SC |title=Minocycline as a cause of drug-induced autoimmune hepatitis. Report of four cases and comparison with autoimmune hepatitis |journal=Am. J. Clin. Pathol. |volume=114 |issue=4 |pages=591–8 |year=2000 |pmid=11026106 |doi=10.1309/KV2J-VX6Q-L95V-VDE4 |url=}}</ref>
 
===Social History===
 
===Family History===


===Common Symptoms===
===Common Symptoms===
Common symptoms of Autoimmune hepatitis include:<ref name="pmid21760995">{{cite journal |vauthors=Makol A, Watt KD, Chowdhary VR |title=Autoimmune hepatitis: a review of current diagnosis and treatment |journal=Hepat Res Treat |volume=2011 |issue= |pages=390916 |year=2011 |pmid=21760995 |pmc=3132488 |doi=10.1155/2011/390916 |url=}}</ref><ref name="pmid23033899">{{cite journal |vauthors=Kim BH, Kim YJ, Jeong SH, Tak WY, Ahn SH, Lee YJ, Jung EU, Lee JI, Yeon JE, Hwang JS, Um SH, Seo YS, Kim YS, Song BC, Kim JH, Jung YK, Park CK, Kim KA, Min HJ, Cho EY, Lee ES, Kwon SY, Chae HB, Kim DJ, Shin SR |title=Clinical features of autoimmune hepatitis and comparison of two diagnostic criteria in Korea: a nationwide, multicenter study |journal=J. Gastroenterol. Hepatol. |volume=28 |issue=1 |pages=128–34 |year=2013 |pmid=23033899 |doi=10.1111/j.1440-1746.2012.07292.x |url=}}</ref><ref name="pmid18084114">{{cite journal |vauthors=Miyake Y, Iwasaki Y, Takaki A, Kobashi H, Sakaguchi K, Shiratori Y |title=Clinical features of Japanese elderly patients with type 1 autoimmune hepatitis |journal=Intern. Med. |volume=46 |issue=24 |pages=1945–9 |year=2007 |pmid=18084114 |doi= |url=}}</ref><ref name="pmid16699618">{{cite journal |vauthors=Bellomo-Brandão MA, Costa-Pinto EA, De Tommaso AM, Hessel G |title=Clinical and biochemical features of autoimmune hepatitis in 36 pediatric patients |journal=Arq Gastroenterol |volume=43 |issue=1 |pages=45–9 |year=2006 |pmid=16699618 |doi=/S0004-28032006000100012 |url=}}</ref><ref name="pmid20821236">{{cite journal |vauthors=Yasui S, Fujiwara K, Yonemitsu Y, Oda S, Nakano M, Yokosuka O |title=Clinicopathological features of severe and fulminant forms of autoimmune hepatitis |journal=J. Gastroenterol. |volume=46 |issue=3 |pages=378–90 |year=2011 |pmid=20821236 |doi=10.1007/s00535-010-0316-3 |url=}}</ref>   
Common symptoms of autoimmune hepatitis include:<ref name="pmid21760995">{{cite journal |vauthors=Makol A, Watt KD, Chowdhary VR |title=Autoimmune hepatitis: a review of current diagnosis and treatment |journal=Hepat Res Treat |volume=2011 |issue= |pages=390916 |year=2011 |pmid=21760995 |pmc=3132488 |doi=10.1155/2011/390916 |url=}}</ref><ref name="pmid23033899">{{cite journal |vauthors=Kim BH, Kim YJ, Jeong SH, Tak WY, Ahn SH, Lee YJ, Jung EU, Lee JI, Yeon JE, Hwang JS, Um SH, Seo YS, Kim YS, Song BC, Kim JH, Jung YK, Park CK, Kim KA, Min HJ, Cho EY, Lee ES, Kwon SY, Chae HB, Kim DJ, Shin SR |title=Clinical features of autoimmune hepatitis and comparison of two diagnostic criteria in Korea: a nationwide, multicenter study |journal=J. Gastroenterol. Hepatol. |volume=28 |issue=1 |pages=128–34 |year=2013 |pmid=23033899 |doi=10.1111/j.1440-1746.2012.07292.x |url=}}</ref><ref name="pmid18084114">{{cite journal |vauthors=Miyake Y, Iwasaki Y, Takaki A, Kobashi H, Sakaguchi K, Shiratori Y |title=Clinical features of Japanese elderly patients with type 1 autoimmune hepatitis |journal=Intern. Med. |volume=46 |issue=24 |pages=1945–9 |year=2007 |pmid=18084114 |doi= |url=}}</ref><ref name="pmid16699618">{{cite journal |vauthors=Bellomo-Brandão MA, Costa-Pinto EA, De Tommaso AM, Hessel G |title=Clinical and biochemical features of autoimmune hepatitis in 36 pediatric patients |journal=Arq Gastroenterol |volume=43 |issue=1 |pages=45–9 |year=2006 |pmid=16699618 |doi=/S0004-28032006000100012 |url=}}</ref><ref name="pmid20821236">{{cite journal |vauthors=Yasui S, Fujiwara K, Yonemitsu Y, Oda S, Nakano M, Yokosuka O |title=Clinicopathological features of severe and fulminant forms of autoimmune hepatitis |journal=J. Gastroenterol. |volume=46 |issue=3 |pages=378–90 |year=2011 |pmid=20821236 |doi=10.1007/s00535-010-0316-3 |url=}}</ref>   
*Fatigue
*[[Fatigue]]
*Lethargy
*[[Lethargy]]
*Upper abdominal discomfort
*[[Abdominal discomfort]]
*Mild pruritus
*Mild [[pruritus]]
*Anorexia
*[[Anorexia]]
*Myalgia
*[[Myalgia]]
*Diarrhea
*[[Diarrhea]]
*Arthralgias involving small joints
*[[Arthralgias]] involving small joints
*Dark urine  
*Dark [[urine]]
*Pale or gray-colored stools
*Pale or gray-colored [[stools]]
*skin rashes
*Skin rashes
*Weight loss
*[[Weight loss]]
===Less Common Symptoms===
===Less Common Symptoms===
Less common symptoms of Autoimmune hepatitis include :
Less common symptoms of autoimmune hepatitis include:
*Edema
*[[Edema]]
*Acne
*[[Acne]]
*Hirsutism
*[[Hirsutism]]
*Amenorrhea
*[[Amenorrhea]]
*Chest pain from pleuritis
*[[Chest pain]] from [[pleuritis]]
Extrahepatic manifestations are generally due to the company that AH keeps:
:* [[Chronic autoimmune thyroiditis]]
:* [[Hyperthyroidism]] ([[Graves’ disease]])
:* [[Ulcerative colitis]]
:* [[Hemolytic anemia]]
:* [[Idiopathic thrombocytopenia]]
:* [[Diabetes mellitus]]
:* [[Diabetes insipidus]]
:* [[Celiac disease]]
:* [[Polymyositis]]
:* [[Myasthenia gravis]]
:* [[Pulmonary fibrosis]]
:* [[Pericarditis]]
:* [[Glomerulonephritis]]
:* [[pityriasis|Acute lichenoid pityriasis]]
:* [[panniculitis|Febrile panniculitis]]
:* [[Hypereosinophilic syndrome]]
:* [[Sjogren’s syndrome]]
:* [[Mixed connective tissue disease]]


==References==
==References==

Latest revision as of 01:09, 2 January 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: :Manpreet Kaur, MD [2]

Overview

Patient with autoimmune hepatitis presents asymptomatic or with symptoms of acute liver failure. A positive history of viral infections like hepatitis A, C, and drug intake like minocycline, interferon α, nitrofurantoin, infliximab, ezetimibe, interferon β, ornidazole, diclofenac, indomethacin, terbinafine, methyldopa, ranitidine, atorvastatin, fluvastatin, fibrates, adalimumab is suggestive of autoimmune hepatitis. The common symptoms of autoimmune hepatitis include jaundice, fatigue, and abdominal discomfort. Less common symptoms of autoimmune hepatitis include acne, edema, hirsutism, amenorrhea.

History

Past Medical History

Medication History

Common Symptoms

Common symptoms of autoimmune hepatitis include:[11][12][13][14][15]

Less Common Symptoms

Less common symptoms of autoimmune hepatitis include:

References

  1. Nagasaki F, Ueno Y, Mano Y, Igarashi T, Yahagi K, Niitsuma H, Okamoto H, Shimosegawa T (2005). "A patient with clinical features of acute hepatitis E viral infection and autoimmune hepatitis". Tohoku J. Exp. Med. 206 (2): 173–9. PMID 15888974.
  2. Castellote J, Güell E, Porta F (2001). "[Autoimmune hepatitis following cytomegalovirus infection]". Med Clin (Barc) (in Spanish; Castilian). 117 (2): 76. PMID 11446931.
  3. Kamisako T, Tsubaki K, Adachi Y, Kamisato T (1997). "Autoimmune hepatitis after cytomegalovirus infection in a bone marrow-transplanted patient". Am. J. Gastroenterol. 92 (7): 1238–9. PMID 9219819.
  4. Huppertz HI, Treichel U, Gassel AM, Jeschke R, Meyer zum Büschenfelde KH (1995). "Autoimmune hepatitis following hepatitis A virus infection". J. Hepatol. 23 (2): 204–8. PMID 7499793.
  5. Vento S, Cainelli F (2004). "Is there a role for viruses in triggering autoimmune hepatitis?". Autoimmun Rev. 3 (1): 61–9. doi:10.1016/S1568-9972(03)00053-3. PMID 14871651.
  6. Gleeson D, Heneghan MA (2011). "British Society of Gastroenterology (BSG) guidelines for management of autoimmune hepatitis". Gut. 60 (12): 1611–29. doi:10.1136/gut.2010.235259. PMID 21757447.
  7. Colmegna I, Perandones CE, Chaves JG (2000). "Minocycline induced lupus and autoimmune hepatitis". J. Rheumatol. 27 (6): 1567–8. PMID 10852297.
  8. Heathcote EJ (1995). "Autoimmune hepatitis and chronic hepatitis C: latent or initiated by interferon therapy?". Gastroenterology. 108 (6): 1942–4. PMID 7539390.
  9. Germano V, Picchianti Diamanti A, Baccano G, Natale E, Onetti Muda A, Priori R, Valesini G (2005). "Autoimmune hepatitis associated with infliximab in a patient with psoriatic arthritis". Ann. Rheum. Dis. 64 (10): 1519–20. doi:10.1136/ard.2004.032821. PMC 1755231. PMID 16162908.
  10. Goldstein NS, Bayati N, Silverman AL, Gordon SC (2000). "Minocycline as a cause of drug-induced autoimmune hepatitis. Report of four cases and comparison with autoimmune hepatitis". Am. J. Clin. Pathol. 114 (4): 591–8. doi:10.1309/KV2J-VX6Q-L95V-VDE4. PMID 11026106.
  11. Makol A, Watt KD, Chowdhary VR (2011). "Autoimmune hepatitis: a review of current diagnosis and treatment". Hepat Res Treat. 2011: 390916. doi:10.1155/2011/390916. PMC 3132488. PMID 21760995.
  12. Kim BH, Kim YJ, Jeong SH, Tak WY, Ahn SH, Lee YJ, Jung EU, Lee JI, Yeon JE, Hwang JS, Um SH, Seo YS, Kim YS, Song BC, Kim JH, Jung YK, Park CK, Kim KA, Min HJ, Cho EY, Lee ES, Kwon SY, Chae HB, Kim DJ, Shin SR (2013). "Clinical features of autoimmune hepatitis and comparison of two diagnostic criteria in Korea: a nationwide, multicenter study". J. Gastroenterol. Hepatol. 28 (1): 128–34. doi:10.1111/j.1440-1746.2012.07292.x. PMID 23033899.
  13. Miyake Y, Iwasaki Y, Takaki A, Kobashi H, Sakaguchi K, Shiratori Y (2007). "Clinical features of Japanese elderly patients with type 1 autoimmune hepatitis". Intern. Med. 46 (24): 1945–9. PMID 18084114.
  14. Bellomo-Brandão MA, Costa-Pinto EA, De Tommaso AM, Hessel G (2006). "Clinical and biochemical features of autoimmune hepatitis in 36 pediatric patients". Arq Gastroenterol. 43 (1): 45–9. doi:/S0004-28032006000100012 Check |doi= value (help). PMID 16699618.
  15. Yasui S, Fujiwara K, Yonemitsu Y, Oda S, Nakano M, Yokosuka O (2011). "Clinicopathological features of severe and fulminant forms of autoimmune hepatitis". J. Gastroenterol. 46 (3): 378–90. doi:10.1007/s00535-010-0316-3. PMID 20821236.

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