Mesalazine
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Acute autoimmune hepatitis: case report A 56-year-old man developed acute autoimmune hepatitis during treatment with mesalazine for Crohn’s disease. The man, who had a history of Crohn’s disease, was hospitalised due to jaundice and nausea. Physical examination revealed no fever or tenderness of abdomen. Seven months earlier, he was diagnosed with Crohn’s disease and had no liver dysfunction prior to mesalazine therapy. He was initiated on mesalazine 4gm daily [route not stated]. Five months later, Crohn’s disease was found to be in clinical and biochemical remission. He had no other medical history, and there was no abuse of alcohol or nicotine. Laboratory examinations at current presentation, revealed elevated liver enzymes with maintained liver function. There were no signs of any inflammation. Abdominal ultrasound revealed a normal aspect of the liver with a normal size of intra and extra-hepatic bile ducts. There was no evidence for any viral infection. Furthermore, there was no evidence for hemochromatosis, a1 antitrypsin deficiency or sarcoidosis. Other test reports were as follows: an elevated titer of immunoglobulin G, antinuclear antibodies and anti-smooth muscle antibodies were found positive. Anti-liver-kidney membrane antibody and anti-mitochondrial antibodies were found to be negative. Two weeks later, a liver biopsy was performed, and histological examination revealed lobular inflammation with cholestasis and formation of a single granuloma with mild to moderate portal inflammation. There were no signs of long standing inflammation as fibrous septa and no portal fibrosis of significance was identified. A diagnosis of mesalazine induced acute autoimmune hepatitis was made. The man’s treatment with mesalazine was discontinued. Two months later, liver enzymes were found to be normalised. No recurrence was noted after 6 months follow-up. Ter Avest MM, et al. Mesalazine induced autoimmune hepatitis in a patient with Crohn’s disease. Clinics and Research in Hepatology and Gastroenterology : no pagination, 4 803519814 Nov 2020. Available from: URL: http://doi.org/10.1016/j.clinre.2020.09.012
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Reactions 12 Dec 2020 No. 1834
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