A 48-year-old woman with a new diagnosis of autoimmune hepatitis.

摘要

A 48-year old woman is referred to you for recently identified serum aminotransferase elevations after presenting with generalized arthralgias and a sense of malaise. Blood test results include aspartate aminotransferase (AST) of 386 U/L (normal, 12-45 U/L) and alanine aminotransferase (ALT) of 510 U/L (normal, 9-50 U/L). The alkaline phosphatase level is mildly elevated at 186 U/L (normal, 80 -115 U/L), and the total bilirubin is 0.8 mg/dL (normal, 0.1-1 mg/dL),. Additional laboratory work revealed negative serologic markers for hepatitis A, B, and C. Serum autoantibodies were performed and included antinuclear antibody (ANA) of >l:80, positive anti-smooth muscle antibody (SMA) of 1:40, gamma-globulin level of 3.2 g/dL (normal, 0.8-1.5 g/dL), negative antimitochondrial antibody, and negative anti-liver/kidney microsomal (anti-LKM) antibody titer. There is no history of alcohol use, and the patient uses no hepatotoxic medications.