Co-occurrence of Wilson disease and Auto-Immune Hepatitis in 14-year-old female: A case report

Authors

  • Fadwa Ghassan Hameed Department of Pharmacy, Al-Kitab University, Kirkuk, Iraq.
  • Inam Sameh Arif Department of Pharmacology and Toxicology, College of Pharmacy, University of Al-Mustanseriah, Baghdad, Iraq.
  • Mohammed Mahmood Mohammed Department of Clinical Pharmacy, College of Pharmacy, University of Al-Mustanseriah, Baghdad, Iraq
  • Hala S. Arif Department Pediatric, College of Medicine, Al-Nahrain University, Baghdad, Iraq.*University, Baghdad, Iraq

DOI:

https://doi.org/10.32947/ajps.v21i2.803

Keywords:

Autoimmune liver disease, Histopathology, Wilson’s disease, Kayser–Fleischer rings.

Abstract

Unusual cases of coexistence between Wilson's disease and autoimmune hepatitis have occurred. There are characteristics of both diseases in this community of patients, and laboratory and histo pathological findings can be misleading. Wilson disease's clinical appearance can differ widely; thus,

there is not always an easy diagnosis. In addition to being childhood and young adult illnesses, Wilson's disease can also be triggered at any age. Liver disease and cirrhosis, neuropsychiatric disorders, Kayser-Fleischer(KF.) rings, and acute hemolysis events are the primary characteristics of Wilson's disease, frequently in combination with acute liver failure. Diagnosis is extremely difficult for children and adults with active liver disease. None of the latest Wilson's disease laboratory tests are optimal and may not be specific. Therefore, by taking into account acute hepatitis similar to Wilson's disease and autoimmune hepatitis, concomitant treatment with immunosuppression and penicillamine may have a superior impact.

References

- Trivedi PJ, Hirschfield GM. overlap syndromes and autoimmune liver disease. Alimentary Pharmacol Ther. 2012 Sep;36(6):517-33. DOI: https://doi.org/10.1111/j.1365-2036.2012.05223.x

- Dara N, Imanzadeh F, Sayyari AA, Nasri P, Hosseini AH. Simultaneous presentation of Wilson’s disease and autoimmune hepatitis; a case report and review of literature. Hepatitis monthly. 2015 Jun;15(6).

- Yener S, Akarsu M, Karacanci C, Sengul B, Topalak O, Biberoglu K, et al. Wilson's disease with coexisting autoimmune hepatitis. J Gastroenterol Hepatol. 2004;19(1):114-6.

- Milkiewicz P, Saksena S, Hubscher SG, Elias E. Wilson's disease with superimposed autoimmune features: report of two cases and review. J Gastroenterol Hepatol. 2000;15 (5):570-4.

- Czaja AJ.Diverse manifestations and evolving treatments of autoimmune hepatitis. Minerva Gastroenterol Dietol. 2005; 51:313–333.

- Czaja AJ. Special clinical challenges in autoimmune hepatitis: the elderly, males, pregnancy, mild disease, fulminant onset, and nonwhite patients. Semin Liver Dis. 2009; 29:315–330. doi: 10.1055/s-0029-1233530. DOI: https://doi.org/10.1055/s-0029-1233530

- Czaja AJ, Bianchi FB, Carpenter HA, et al. Treatment challenges and investigational opportunities in autoimmune hepatitis. Hepatology.2005;41:207–15. DOI: https://doi.org/10.1002/hep.20539

- Czaja AJ. Difficult treatment decisions in autoimmune hepatitis.World J Gastroenterol.2010;16:934–47. DOI: https://doi.org/10.3748/wjg.v16.i8.934

- Ahmad A, Torrazza-Perez E, Schilsky ML. Liver transplantation for Wilson disease. Handb Clin Neurol 2017; 142:193-204. DOI: https://doi.org/10.1016/B978-0-444-63625-6.00016-1

- European Association for Study of Liver. EASL Clinical Practice Guidelines: Wilson’sdisease. J Hepatol 2012;56. DOI: https://doi.org/10.1016/j.jhep.2011.11.007

- Stremmel W, Meyerrose KW, Niederau C, et al. Wilson disease: clinical presentation,treatment, and survival. Ann Intern Med 1991; 115:720. DOI: https://doi.org/10.7326/0003-4819-115-9-720

- Couto C, Bittencourt P. Controvérsias no diagnóstico e tratamento da hepatite autoimune.In: Savassi-Rocha P, Coelho L, Sanches M, eds. Tópicos em Gastroenterologia14 - Controvérsias. Rio de Janeiro: Guanabara Koogan, 2015.

- Santos RG, Alissa F, Reyes J, et al. Fulminant hepatic failure: Wilson’s disease or autoimmune hepatitis? implications for transplantation. Pediatr Transplant 2005; 9:112–6. DOI: https://doi.org/10.1111/j.1399-3046.2005.00254.x

- Milkiewicz P, Saksena S, Hubscher SG, et al. Wilson’s disease with superimposed autoimmune features: report of two cases and review. J Gastroenterol Hepatol 2000; 15:570–4.

- Dara N, Imanzadeh F, Sayyari AA, et al. Simultaneous presentation of Wilson’s disease and autoimmune hepatitis; a case report and review of literature. Hepat Mon 2015;15: e29043.

- Loudianos G, Zappu A, Lepori MB, et al. Acute liver failure because of Wilson diseasewith overlapping autoimmune hepatitis features: the coexistence of two diseases? JPediatr Gastroenterol Nutr 2016;63: e23–4.

- Yener S, Akarsu M, Karacanci C, et al. Wilson’s disease with coexisting autoimmune hepatitis. J Gastroenterol Hepatol 2004; 19:114–6.

- Deutsch M, Emmanuel T, Koskinas J. Autoimmune hepatitis or Wilson’s disease, aclinical dilemma. Hepat Mon 2013;13: e7872

- Jang HJ, Jang JY, Kim KM. Appendiceal orifice inflammation in an 8-year-old girl with ulcerative colitis complicating Wilson’s disease. Gut Liver 2010; 4:126. DOI: https://doi.org/10.5009/gnl.2010.4.1.126

- Alvarez F, Berg PA, Bianchi FB, Bianchi L, Burroughs AK, Cancado EL, et al. International Autoimmune Hepatitis Group Report: review of criteria for diagnosis of autoimmune hepatitis. J Hepatol 1999; 31:92938. DOI: https://doi.org/10.1016/S0168-8278(99)80297-9

- Ebbeson RL, Schreiber RA. Diagnosing autoimmune hepatitis in children: is the International Autoimmune Hepatitis Group scoring system useful? Clin Gastroenterol Hepatol 2004; 2:935. DOI: https://doi.org/10.1016/S1542-3565(04)00396-9

- Archer GJ, Monie RD. Wilson’s disease and chronic active hepatitis. Lancet 1977; i:486. DOI: https://doi.org/10.1016/S0140-6736(77)91974-2

- Scott J, Gollan JL, Samourian S, Sherlock S. Wilson’s disease, presenting as chronic active hepatitis. Gastroenterology 1978; 74:645. DOI: https://doi.org/10.1016/0016-5085(78)90238-X

- Perman JA, Werlin SL, Grand RJ, Watkins JB. Laboratory measures of copper metabolism in the differentiation of chronic active hepatitis and Wilson disease in children. J Pediatr 1979; 94:5648. DOI: https://doi.org/10.1016/S0022-3476(79)80011-6

- Milkiewicz P, Saksena S, Hubscher SG, Elias E. Wilson’s disease with superimposed autoimmune features: report of two cases and review. JGastroenterol Hepatol 2000; 15:570. DOI: https://doi.org/10.1046/j.1440-1746.2000.02158.x

- Yener S, Akarsu M, Karacanci C, Sengul B, Topalak O, Biberoglu K, et al. Wilson’s disease with coexisting autoimmune hepatitis. J Gastroenterol Hepatol 2004; 19:114. DOI: https://doi.org/10.1111/j.1440-1746.2004.03254.x

- Deutsch M, Emmanuel T, Koskinas J. Autoimmune hepatitis or Wilson’s disease, a clinical dilemma. Hepat Mon 2013;13: e7872. DOI: https://doi.org/10.5812/hepatmon.7872

- Bruno Campos Santos, Ludmila Resende Guedes, Luciana Costa Faria and Claudia Alves Couto. Case report:Wilson’s disease presentation resembling autoimmune hepatitis.BMJ case report. October 25, 2019.

- Dara N, Imanzadeh F, Sayyari AA, Nasri P, Hosseini AH. Simultaneous presentation of Wilson’s disease and autoimmune hepatitis; a case report and review of literature. Hepat Mon 2015;15: e29043. DOI: https://doi.org/10.5812/hepatmon.29043

- Loudianos G, Zappu A, Lepori MB, Dessi V, Mameli E, Orru S, et al. Acute liver failure because of Wilson disease with overlapping autoimmune hepatitis features: the coexistence of two diseases? J Pediatr Gastroenterol Nutr 2016;63: e23. DOI: https://doi.org/10.1097/MPG.0000000000000557

- Sallie R, Chiyende J, Tan KC, Bradley D, Portmann B, Williams R, et al. Fulminant hepatic failure resulting from coexistent Wilson’s disease and hepatitis E. Gut 1994;35:849. DOI: https://doi.org/10.1136/gut.35.6.849

- Nery FG, Marques I, Magalhaes M, Miranda HP. Wilson’s disease and ulcerative colitis in the same patient: just a coincidence? A case report and literature review. Gastroenterology Res 2010; 3:287. DOI: https://doi.org/10.4021/gr271w

- Boga S, Jain D, Schilsky ML. Trientine induced colitis during therapy for Wilson disease: a case report and review of the literature. BMC Pharmacol Toxicol 2015; 16:30. DOI: https://doi.org/10.1186/s40360-015-0031-z

- Sood V, Rawat D, Khanna R, Alam S. Cholestatic liver disease masquerading as Wilson disease. Indian J Gastroenterol 2015; 34:174. DOI: https://doi.org/10.1007/s12664-015-0552-9

Downloads

Published

2022-04-19

How to Cite

Fadwa Ghassan Hameed, Inam Sameh Arif, Mohammed Mahmood Mohammed, & Hala S. Arif. (2022). Co-occurrence of Wilson disease and Auto-Immune Hepatitis in 14-year-old female: A case report. Al Mustansiriyah Journal of Pharmaceutical Sciences, 21(2), 1–8. https://doi.org/10.32947/ajps.v21i2.803

Most read articles by the same author(s)