Abstract
Case Summary: This case highlights a rare and diagnostically challenging presentation of liver failure from Autoimmune Hepatitis (AIH) in a 35-year-old male with Human Immunodeficiency Virus (HIV). The patient, initially on antiretroviral therapy (ART) and tuberculosis prophylaxis, presented with a one-month history of abdominal pain, jaundice, acholic stool, tea-colored urine, and nausea. Initial workup suggested obstructive jaundice due to choledocholithiasis and acute calculous cholecystitis, managed by endoscopic retrograde cholangiopancreatography (ERCP) and cholecystectomy. However, the patient’s jaundice and liver enzyme abnormalities persisted postoperatively, prompting further investigation.
Subsequent testing revealed positive anti-smooth muscle antibodies (ASMA) and liver biopsy showed chronic portal and lobular inflammation with cholestasis, confirming the diagnosis of Autoimmune Hepatitis. Common causes of liver dysfunction in HIV such as viral hepatitis and drug-induced liver injury (DILI) were ruled out. Immunosuppressive therapy with Prednisone and Mycophenolate Mofetil stabilized liver function transaminases, but did not normalize bilirubin levels, necessitating a cycle of DPMAS (Double Plasma Molecular Adsorption System), which effectively reduced bilirubin and ammonia levels.
This case underscores the clinical complexity of diagnosing AIH in immunocompromised patients, especially when structural and infectious causes coexist. The successful use of conventional immunosuppression and DPMAS in this context suggests the need for future studies on their safety and efficacy in HIV-positive patients.
Keywords
Case report, Autoimmune hepatitis, HIV, DPMAS