Autoimmune hepatitis (AIH) is a chronic liver inflammation of unknown etiology that is characterized by the presence of circulatory autoantibodies and persistent damage to liver tissue.

In the past few years, it has been discovered that certain agents such as drugs and viruses can possibly trigger the course of self-induced liver damage.

A recent case published on February 28, 2009 in the World Journal of Gastroenterology and presented by Dr. Waleed K Al-Hamoudi from Saudi Arabia shed some light on this concern.

From News-Medical.Net:

A 23-year-old man was referred to their hepatology service on September 1, 2007 with jaundice, anorexia, weight loss and malaise of 2 mo duration. The episode of jaundice was preceded by varicella zoster virus (VZV) infection (chicken pox), which he contracted from close contact with infected family members. Despite recovery from the skin eruption, he had persistent anorexia and intermittent right upper quadrant pain. One month later he developed increasing jaundice. His physical examination revealed jaundice and hepatomegaly 2 cm below the costal margin. His initial laboratory findings were as follows: hemoglobin 149 g/L, white blood cell count 9.9 ~ 109/L, platelets 512 ~ 109/L, erythrocyte sedimentation rate 39 mm/h, alanine aminotransferase (ALT) 1066 U/L, aspartate aminotransferase (AST) 755 U/L, alkaline phosphatase (ALP) 185 U/L, total bilirubin 425 ƒÊmol/L, direct bilirubin 318 ƒÊmol/L, and albumin 32 g/L. His globulins were elevated at 46 g/L and his IgG was also elevated at 20.5 g/L. The coagulation profile was normal. Anti-nuclear, anti-smooth muscle, anti-mitochondrial and antiliver/kidney microsomes (ALKM-1) autoantibodies were negative. Perinuclear antineutrophil cytoplasmic antibodies were positive. Hepatitis B surface antigen, anti-hepatitis B core antigen IgM, anti-hepatitis C virus antibodies, anticytomegalovirus (CMV) IgM, anti-Epstein-Barr virus (EBV) IgM, and anti-hepatitis A virus (HAV) IgM were all negative. Anti-VZV IgG antibodies were positive. Ceruloplasmin and iron indices were normal.

In this case, the patient refused liver biopsy and a tapering prednisone for presumed AIH was provided at a dosage of 60 mg and dramatic responses were noticed. When steroids were tapered below 10 mg, there was an increase in the level of liver enzymes. It was concluded that VZV infection can trigger AIH and AIH must be considered in patients with persistently altered liver enzymes following a viral infection.