Severe hepatic involvement without inflammatory changes in systemic lupus erythematosus: report of two cases and review of the literature

Abstract

Hepatic diseases in systemic lupus erythematosus (SLE) are not rare, but liver biopsies of those cases are usually reported as chronic hepatitis or steroid-induced steatosis. We describe two unusual patients with active SLE who displayed liver dysfunction without inflammatory changes or associated with drug administration. A liver biopsy in case 1 showed massive hepatic cell damage resulting in acute hepatic failure. In case 2, the liver specimen revealed diffuse fatty degeneration without symptoms specific to liver dysfunction. No inflammatory cell infiltrate was observed in the liver tissue of either patient. After steroid pulse therapy (case 1) and the administration of 60 mg/day of prednisolone (case 2), liver function improved in parallel with the stabilization of the other manifestations of SLE. No other causes for liver damage except for SLE were observed in either case. Therefore it is supposed that the liver impairments in these cases were one manifestation of SLE.

Keywords

hepatic involvement no inflammatory changes

Get full access to this article

View all access options for this article.

References

Miller MH et al. The liver in systemic lupus erythematosus. Quart J Med 1984; 211: 401-419.

Gibson T. , Myers AR Subclinical liver disease in systemic lupus erythematosus. J Rheumatol 1981; 8: 752-759.

Runyon BA , Labrecque DR , Anuras S. The spectrum of liver disease in systemic lupus erythematosus. Am J Med 1980; 69: 187-194.

Mackay IR , Taft LI , Cowling DC Lupoid hepatitis and the hepatic lesions of systemic lupus erythematosus. Luncet 1959; 1: 65-69.

Moriwaki Y. et al. Autoimmune hepatitis or hepatic involvement in SLE? A case report. Gastrointerol Jpn 1987; 22: 222-227.

Tan EM et al. The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 1982; 25: 1271-1277.

Pistiner M. et al. Lupus erythematosus in the 1980s: a survey of 570 patients. Semin Arthritis Rheum 1991; 21: 55-64.

Hopf U. , Meyer ZBKH, Arnold W. Detection of a liver-membrane autoantibody in HBsAg-netative chronic active hepatitis. N Engl J Med 1976 ; 294: 578-582.

Hall S. et al. How lupoid is lupoid hepatitis? J Rhematol 1986; 13: 95-98.

10.

Hopf U. et al. Liver membrane antibodies (LMT) recognize a 26-kD protein on the hepatocellular surface. Clin Exp Immunol 1990; 79: 54-61.

11.

Kushimoto K. , Nagasawa K. , Ueda A. et al. Liver abnormalities and liver membrane autoantibodies in systemic lupus erythematosus. Ann Rheum Dis 1989: 48: 946-952.