BMJ Case Reports 2013; doi:10.1136/bcr-2013-008591

Acute hepatitis in a young woman with systemic lupus erythematosus: a diagnostic challenge

  1. João Freitas
  1. Department of Gastrenterology, Hospital Garcia de Orta, Almada, Portugal
  1. Correspondence to Dr Rita Barosa, a.rita.b{at}


A 48-year-old woman with systemic lupus erythematosus diagnosis was on naproxen, hidroxichloroquine and acetylsalicylic acid. She had self-suspended all medication and resumed 1 year later. Five days after the medication was resumed, she developed acute hepatitis, with biochemical hepatic cytolysis, hypergamaglobulinaemia and a serum antinuclear antibody titre of 1/2560. Idiopathic autoimmune hepatitis was considered, but drug-induced liver injury could not definitely be ruled out. Patient declined liver biopsy. Oral prednisolone was started. Within 3 months with prednisolone being tapered to 10 mg/day, a new flare occurred. Liver biopsy was performed and it favoured autoimmune hepatitis diagnosis. We discuss the diagnostic options and treatment approach in a patient with autoimmune disease and possible drug-induced liver injury who initially declined liver biopsy.

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