Systemic lupus erythematosus (SLE) is an autoimmune disorder affecting multiple organs, including the Required parameters Score* liver; the co-occurrence of autoimmune hepatitis (AIH) Female /2
and SLE is considered to be rare. 1,2 The International Ratio of serum alkaline phosphatase to aminotransferase Autoimmune Hepatitis Group has recently presented activities (IU/L) Γ΅3.0 /2 a scoring system for the diagnosis of AIH, 3 which may Total serum globulin, gammaglobulin, or IgG: times upper serve as a tool to differentiate between SLE-associated limit Γ
1.0-1.5 /1 hepatitis and AIH in SLE. Based on these defined crite-Autoantibodies (titers ANA/SMA/LKM-1); adults ΓΊ1:80; ria, we considered the diagnosis of AIH in a patient children ΓΊ1:20 /3 Seronegative for markers hepatitis A, B, and C /3 with SLE, and discuss the value and possible refine-No recent history of hepatotoxic drug usage or parenteral ment of the scoring system for AIH in autoimmune exposure to blood products /1 diseases with hepatic involvement. Average alcohol consumption Γ΅25 g/day /2 Case report. A 20-year-old woman presented with a Other autoimmune disease in patient /1 3-week history of fatigue, malaise, myalgias, episodic fever, and weight loss (6 kg). Complaints of alopecia, Additional parameters Complete response to therapy /2 arthralgias, and a positive Raynaud's phenomenon already existed, with pigmented macules successively Total aggregate score β arising on the palms, soles, and face. There was no Before treatment 15 history of recent hepatotoxic drug usage or parenteral After treatment 17 exposure to blood products. No family history of liver Abbreviations: IgG, immunoglobulin G; ANA, antinuclear antidisease existed. body; SMA, smooth-muscle antibody; LKM-1, liver and kidney micro-On physical examination, her temperature was some antibodies. 40ΠC. Pigmented macules and erythematous lesions * Scoring system for AIH recently defined by the International were prominent on the hands, feet, and nose. Fur-Autoimmune Hepatitis Group. 3 ther examination revealed no joint swelling, and β Interpretation of scores before and after treatment: before, ΓΊ15; neither hepatomegaly nor stigmata of chronic liver after, ΓΊ17; definite AIH; before, 10-15; after 12-17; probable AIH. disease. We considered the diagnosis of AIH in view of raised serum aminotransferases, hypergammaglobulinemia, antinuclear antibodies (titer: 1:10,240), seronegativity