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Revista americana de medicina respiratoria

On-line version ISSN 1852-236X

Abstract

ENGHELMAYER, Juan Ignacio et al. Hepatitis autoinmune y enfermedad pulmonar intersticial difusa: Una asociación poco frecuente: a propósito de un caso. Rev. am. med. respir. [online]. 2015, vol.15, n.1, pp.77-80. ISSN 1852-236X.

Autoimmune diseases can compromise the lung, for example the connective tissue diseases, but little has been published about the association between autoimmune hepatitis (AH) and interstitial lung diseases (ILD). We present a 57 year old woman with hypothyroidism and current smoking habit who complains of dry cough and dyspnea. Physical examination detected isolated crackles in pulmonary bases. Pulse oximetry was 96%. Blood tests showed elevated aminotransferase levels, antinuclear antibody 1/80, anti-smooth muscle antibodies: 1/1280. Spirometry showed forced vital capacity of 85% of predicted value and diffusing capacity for carbon monoxide was 53% of predicted value. Hepatic ultrasonography showed diffuse, lobulated hepatomegaly. Intrahepatic and extrahepatic biliary tracts were preserved without portal hypertension. Liver biopsy demonstrated moderate inflammatory infiltrate and some plasmocytes with extensive hepatitis. At acinar level isolated necroinflammatory foci were observed. The Tricomic Technique showed thick fibrous bands that delimit regenerative nodules. The Chest Tomography showed diffuse interstitial opacities with bilateral ground glass, reticular pattern, few bronchiolectasis and no honeycombing. The case was interpreted as AH plus ILD. The patient refused lung biopsy. There are very few reports in the medical literature describing the association between autoimmune liver disease and pulmonary interstitial involvement. It is important to determine whether this type of autoimmune liver disease shares a common pathophysiological mechanism with ILD, because of the diagnostic and therapeutic implications (e.g. the decision to perform surgical lung biopsy) and possible prognostic significance. We should consider AH and ILD as related diseases with probable common pathophysiological mechanisms.

Keywords : Autoimmune Hepatitis; Interstitial Lung Diseases; Autoimmune Diseases.

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