[Persistent acute hepatitis in a patient with chronic hepatitis C]. / Hepatitis aguda mantenida en paciente con hepatitis crónica C previa.

We describe the case of a patient with chronic hepatitis C (CHC) who showed a progressive increase in aminotransferase level, reaching values of aspartate aminotransferase 1723 UI/L, alanine aminotransferase 1519 UI/L and gamma-glutamyl-transpeptidase 296 with a bilirubin level of 6 mg/dL and direct bilirubin level of 4.6 mg/dL. One year previously, the patient had been diagnosed with CHC, genotype 1, and had an initial hepatitis C virus RNA load of 249,000 UI/mL. All the specific blood tests performed were negative except for antisoluble liver antigen (anti-SLA) antibodies, which were positive in two different determinations. A diagnosis of overlap syndrome CHC and autoimmune hepatitis was made. Steroid and azathioprine treatment was started with good response. The relationship between CHC and anti-SLA is not well characterized but has been described in these patients. We found no prior reports in the literature of CHC associated with positive anti-SLA in a patient with persistent acute hepatitis.

[Autoimmune hepatitis caused by acute hepatitis due to hepatitis A virus]. / Hepatitis autoinmune desencadenada por una hepatitis aguda por virus de la hepatitis A.

We describe the case of a 27-year-old man who presented acute hepatitis due to hepatitis A virus infection. Over the following weeks he consistently presented elevated transaminase levels and jaundice. Antinuclear and anti-smooth muscle antibodies, hypergammaglobulinemia and periportal necrosis were detected in the liver biopsy. The patient was diagnosed with autoimmune hepatitis and responded well to treatment with immunosuppressive drugs. This case, as well as other published reports, suggest that in certain individuals, acute hepatitis A may be the decisive factor leading to autoimmune hepatitis.