A 35-year-old female presented with a history of lethargy
and jaundice. She also complained of joint pains and mild pain in the right
She did not drink and did not take any medications
including over the counter preparations or herbal remedies.
On examination the patient was not obese, she had mild
jaundice and the liver was enlarged 3 fingerbreadths below the costal margin
and was tender.
Investigations revealed normal haematology raised ALT,
ALP and bilirubin.
Gammaglobulin levels were raised and she was positive for
ANA and SMA antibodies.
She was negative for hepatitis B and C viruses and
screening for haemochromatosis, Wilsonís disease and alpha antitrypsin
deficiency was negative.
Ultrasound scanning did not reveal a focal lesion.
Liver biopsy was performed and this showed a
lymphoplasmacellular infiltrate in the portal tracts with necrosis affecting
the limiting plate.
In this patient:
Selective elevation of Ig G antibody is typical
Selective elevation of Ig A antibody is typical
Selective elevation of Ig M antibody is typical
Positive anti SMA is diagnostic of this condition
Positive anti LKM antibody is diagnostic of this condition