Treatment of lupoid hepatitis with azathioprine*

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LUPOID HEPATITIS, a well-recognized entity affecting only young women, is characterized clinically by persistent hepatitis with or without jaundice, recurrent arthritis, dermatitis, and splenomegaly. Histologically, there is parenchymatous infiltration of plasma cells and lymphocytes with various degrees and patterns of hepatic fibrosis. Serologically, there is a great elevation of γ-globulins and the presence of antinuclear and other autoantibodies in the blood. The prognosis in patients with lupoid hepatitis is usually poor, since relentless progression to chronic hepatic disease with subsequent portal hypertension and hepatic failure occurs despite treatment. The features of this disease suggest that lupoid hepatitis is an autoimmune disease.

The possible beneficial results of corticosteroid treatment are thought to be due to their antiinflammatory and immunosuppressive effects, the latter being attributed to inhibition of lymphoid tissue, which is presumably the site of development and proliferation of the forbidden clones responsible for the production of autoantibodies. The use of cytotoxic drugs, because of their immunosuppressive reactions, was suggested by Dameshek and Schwartz1 in 1960 for the management of autoimmune disorders. Alkylating agents and antimetabolites have since been used with variable success in several disease states such as rheumatoid arthritis,2, 3 systemic lupus erythematosus,4 lupoid hepatitis,5 and chronic ulcerative colitis.6 The poor prognosis in lupoid hepatitis5 and the strong possibility that it may be based on autoimmunity, justify the use of patent immunosuppressive drugs in treatment.

The case that we are reporting illustrates some of the outstanding features of lupoid hepatitis and its course under the effect of azathioprine.

Report. . .



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