摘要
In this case report we describe for the first time an association between autoimmune hepatitis （AIH） and uveitis, without any doubts about other possible etiologies, such as HCV, since all the old reports describe the association of AIH with iridocyclitis before tests for HCV-related hepatitis could be available. A 38-year-old businessman with abnormal liver function tests and hyperemia of the bulbar conjunctiva was admitted to the hospital. Six years before admission, the patient presented with persistent fever, arthralgias, conjunctival hyperemia, leukocytosis and increased ESR, referred to acute rheumatic fever. The presence of systemic diseases, most commonly associated with uveitis, was investigated without results and the patient was then treated with topical corticosteroids. His symptoms resolved. A test for anti-nuclear antibodies was positive, at a titre of 1：320, with a speckled and nucleolar staining pattern. Liver ultrasound showed mild hepatomegaly with an increased echostructure of the liver. Percutaneous liver biopsy was performed under ultrasound assistance. Histological examination showed necroinflammation over the portal, periportal and Iobular areas, fibrotic portal tracts, with periportal fibrosis and occasional portal-to-portal bridgings, but intact hepatic architecture. Some hepatocytes showed barely discernible granules of hemosiderin in the Iobular area. Bile ductules had not any significant morphological alterations. METAVIR score was A2-F3, according to the modified HAI grading/fibrosis staging. The patient was diagnosed to have AIH with mild activity and fibrosis and was discharged on 25 mg prednisone, entering clinical and biochemical remission, further confirming diagnosis. After discharge the patient continued to have treatment with corticosteroids as an outpatient at a dose of 5 mg. On January 2002 the patient was readmitted to the hospital. A test for anti-nuclear antibodies was positive, at a titre of 1：320, with a speckled and nucleolar staining pattern. Anti-smooth muscle antibody test was also positive （1：160）, while anti-LKM antibodies were negative. Ophthalmologic examination revealed inflammatory cells and proteinaceous flare in the anterior chamber of the left eye, and a stromal lesion in the cornea. He was maintained on immunosuppressive therapy （5 mg prednisone plus topical antibiotic therapy for two weeks） and then discharged. A complete remission of the symptoms was registered on follow-up. At present （July 2005）, the patient is on prednisone （5 rag） and has no symptoms. Liver function tests are also within the normal range.
在这份病案报告，我们第一次描述在自体免疫的肝炎(AIH ) 和眼色素层炎之间的一个协会，没有关于另外的可能的病原学的任何疑问，例如 HCV，自从在为 HCV 相关的肝炎的测试能是可得到的以前，所有旧报告与虹膜睫状体炎描述 AIH 的协会。有反常的肝功能测试和球结膜的充血的一个 38 岁的商人进入医院。在承认，与坚持的发烧介绍的病人，关节痛，结膜充血，白细胞增多和增加的 ESR 前的六年，指了尖锐风湿热。系统病的存在，通常与眼色素层炎联系的大多数，没有结果，被调查，病人然后与热门 corticosteroids 被对待。他解决的症状。为反原子的抗体的测试是阳性的，在 1:320 的一个效价，与一个有斑点、核仁的染色的模式。肝超声与肝的增加的回响结构显示出温和肝肿大。经皮的肝活体检视在超声帮助下面被执行。组织学的检查在门，仙子门和小叶片的区域上显示出 necroinflammation，纤维变性门道与仙子门纤维变性和偶尔的 portal-to-portal bridgings，但是未经触动的肝的建筑学。某 hepatocytes 在小叶片的区域显示出含铁血黄素的恰好看得清的小粒。胆小管没有任何重要词法改变。METAVIR 分数是 A2-F3，根据修改 HAI 等级 / 纤维变性阶段。病人被诊断与温和活动和纤维变性有 AIH 并且在 25 mg 泼尼松上被解除，进入临床、生物化学的宽恕，进一步的证实诊断。在分泌物以后，病人继续在 5 mg 的剂量作为一个门诊病人与 corticosteroids 有治疗。在 2002 年 1 月，病人被重新接纳到医院。为反原子的抗体的测试是阳性的，在 1:320 的一个效价，与一个有斑点、核仁的染色的模式。反光滑的肌肉抗体测试也是阳性的(1:160 ) ，当 anti-LKM 抗体是否定的时。眼科学检查在角膜在左眼，和基质损害的前房揭示了煽动性的房间和 proteinaceous 闪光。他在抑制免疫力的治疗(加为二个星期的热门抗菌素治疗的 5 mg 泼尼松) 上被维持然后排出。症状的完全的宽恕在后续上被登记。目前(2005 年 7 月) ，病人在泼尼松(5 mg ) 上并且没有症状。肝功能测试也在正常范围以内。
