(Disclaimer: This article is for scientific use only, and the information in the following content has been processed to protect patient privacy)
Abstract: In this case, the patient was found to have abnormal liver function during physical examination, and the patient reported that he had symptoms of pruritus without obvious causes and significant weakness in the past 2 months. The patient was in remission and the progression of liver disease was controlled in time.
Basic information】Female, 24 years old
Disease Type】Autoimmune liver disease, primary biliary cholangitis
Hospital】Huangshi Traditional Chinese Medicine Hospital
Date of Consultation】May 2020
Treatment plan】Medication (magnesium isoglycyrrhizate injection, prednisolone tablets, ursodeoxycholic acid capsules)
Treatment period】Inpatient treatment for 2 weeks, outpatient follow up
Treatment effect] Liver function returned to normal
I. Initial consultation
The patient is 24-year-old Ms. Cui, who complained of itchy skin and weakness without any obvious cause in the past 2 months, and was found to have abnormal liver function on physical examination 2 days ago. On examination: the patient’s hepatitis B diastery quantification: HBsAg: 0.1ng/ml; HBsAb 42.640mIU/ml (↑). Since the main manifestation was abnormal liver function but the cause was unknown, the preliminary diagnosis was abnormal liver function. After admission, auxiliary examinations were completed, and the blood routine, urine routine, stool routine, renal function, blood lipids, blood glucose, and cardiac enzyme profile were normal, and the four coagulation items, hepatitis A, hepatitis E, and hepatitis C antibodies were negative.
II. Treatment history
At present, because the cause of liver function abnormalities is unknown, ursodeoxycholic acid capsules and other medications were given temporarily. Because hepatitis A, B, C and E virus infections were ruled out, hereditary metabolic liver disease was ruled out, there was no history of drug use or alcohol consumption before the onset of the disease, drug-related liver damage and alcoholic liver disease were ruled out, and the patient had significantly elevated liver function ALP and GGT, positive anti-mitochondrial M2 antibodies and elevated immunoglobulin M. Therefore, primary biliary cholangitis was considered. At the same time, the patient was strongly positive for antinuclear antibodies, and immunoglobulin G was significantly elevated in the serum. Further liver aspiration examination was performed to confirm the diagnosis of autoimmune hepatitis, and the patient was treated with prednisolone tablets immunosuppressant. After 2 weeks of treatment, the patient’s liver function did not improve significantly, so the treatment regimen was adjusted, and a loading dose of prednisolone tablets was added to ursodeoxycholic acid capsules and magnesium isoglycyrrhizate injection.
III. Treatment effect
The patient’s condition gradually improved, and after 2 weeks of hospitalization, the patient was still mentally well, with normal physical strength and appetite, the wound at the puncture site healed without bleeding or infection, and the patient had normal urine and stool, so the patient was discharged. Fifteen days after discharge, the patient was re-examined and although the autoimmune liver disease could not be completely cured, the patient basically recovered from the discomfort and no recurrence of the disease was found. The patient and his family were very satisfied with the treatment effect.
IV. Notes
We are glad that the patient’s condition is under control, but we need to remind the patient. After being discharged from the hospital, the patient should pay attention to the lifestyle adjustment, diet, mainly low-fat diet, more vegetables and fruits and high-quality protein, such as fish, chicken, milk, eggs, etc.; stay away from strong tea, coffee and staying up late and other bad habits. 3-6 months regular physical examination by the hepatologist, including blood routine, liver function, immunoglobulin and ultrasound, etc., taking hormone drugs also pay attention to calcium supplementation, can take In addition, patients can exercise to enhance physical fitness and prevent osteoporosis and infection.
V. Personal insight
Autoimmune liver disease is mostly seen in women, with a high prevalence in middle-aged and elderly people, and is not uncommon in younger people, with primary biliary cholangitis and autoimmune hepatitis being the most common. With the widespread clinical development of antibody profiles for autoimmune liver disease, diagnosis is not difficult, but the existence of overlapping syndromes cannot be ignored. In terms of confirming the diagnosis, pathological examination is more conducive to the detection of occult autoimmune liver disease, as well as to the assessment of the grade of liver inflammation and fibrosis, and to the development of an individualized treatment plan. As in the present case, the patient sought timely medical attention, clarified the condition through a series of tests, and treated aggressively; the patient’s prognosis is good.