6/29/2023 0 Comments Positive scleral icterusOf note, statistically significant increases in sepsis have not been shown for AIH patients treated with steroids. The development of hepatic encephalopathy or lack of biochemical response or improvement after one to two weeks of steroid therapy requires a consideration for liver transplant. The most crucial element of AS-AIH management is determining whether urgent liver transplant evaluation should be initiated. MELD labs once or twice daily should be measured, and if there is biochemical and clinical improvement by seven days, the steroids should be tapered and azathioprine can be considered as an adjunctive agent. Hospitalization is recommended for close monitoring not only for biochemical response but also for lack of clinical improvement and potential progression to acute liver failure. The recommended medication and dose is prednisolone 0.5-1mg/kg/day. Response rates vary, ranging from 20%-100%. The first line therapy for AS-AIH is corticosteroids. Taken from: Approach to the Patient with Acute Severe Autoimmune Hepatitis. Ultimately, there are gold standard criteria that incorporate labs, serology, and histology to diagnose AIH definitively. S), hepatosplenom egaly, scleral icterus, exudative tonsillopharyngitis, cervical adenopathy 304/188 241/236 4.6 (3.6) 22.1 - (25) 8. Interface hepatitis, hepatocyte rosettes, and emperipolesis (one cell telescoping into another) are common histologic findings in AIH (Figure 2). Along with excluding these other conditions, the diagnosis of AIH-if not already definitively diagnosed- can be secured with positive serologic markers such as anti-nuclear antibodies, anti-smooth muscle antibodies, or anti-liver kidney microsome antibodies, and a liver biopsy, which is the gold standard of diagnosis. Drug-induced liver injury, autoimmune cholangiopathy, Wilson's disease, and Budd-Chiari syndrome are other liver diseases that can present similarly. In addition, hepatitis E virus testing, which is a rare mimicker of AS-AIH, must be excluded. Viral hepatitis can present similarly to AS-AIH, thus testing for hepatitis A, B, C, along with herpes simplex virus, Epstein-Barr virus, cytomegalovirus, varicella-zoster virus, and parvovirus should be carried out. Because the treatment of choice is corticosteroids, which carry a risk of harmful side effects including infection, other conditions must be ruled out. Making a diagnosis of acute severe autoimmune hepatitis (AS-AIH) is critical to providing safe, rapid treatment. Establishing the Diagnosis of Acute Severe Autoimmune Hepatitis Taken from: Acute Severe Autoimmune Hepatitis: Corticosteroids or Liver Transplantation? Liver Transplantation 2019.
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