Issue Three 2015
2015, Vol. 2, issue 3, (November)
Case Reports
Oncofetal proteins in autoimmune- like hepatitis induced by herbals: a case report
Abstract:
We present a 56-years-old patient with a clinical and biochemical picture of acute hepatitis, but for the fourth time in her life after an eighteen- years period with normal liver tests. The patient had also had concomitant increase in alpha- fetal protein (AFP). After exclusion of viral hepatitis, hemochromatosis and liver cancer, we assumed the diagnosis of autoimmune-like hepatitis, probably caused by a two-years intake of herbals – Samento and Echinacea. The conducted image investigations did not fiound cancer, despite the increased vitamin B12 level and carbohydrate antigen CA19-9. The histological pattern of damage resembled autoimmune cirrhosis, without convincing biological data for autoimmune hepatitis and clinical signs of cirrhosis. Treatment with corticosteroids and imuran (azathioprine) led to normalization of liver transaminases, vitamin B12 and ferritin levels. Increased levels of AFP, usually slight, haved been reported in acute viral and autoimmune hepatitis, and during Echinacea intake. Elevated CA 19-9 have alsod been also reported in single cases of autoimmune hepatitis and in benign conditions. In our patient both tumour markers were increased, most likely due to the autoimmune-like hepatitis, induced by the taken herbals. After initiation of therapy, AFP quickly reached the normal level, while CA 19-9 decreased slowly during the follow-up. One year later the liver histology was similar to the initial one.
Authors:
Radosveta Tomova; Clinic of Gastroenterology, St. Ivan Rilsky University Hospital, Sofia, Bulgaria;Marija Pishmisheva; Infectious Department, Hospital, Pazardgik, Bulgaria;
Radina Ivanova; Clinic of Gastroenterology, St. Ivan Rilsky University Hospital, Sofia, Bulgaria;
Deian Jelev; Clinic of Gastroenterology, St. Ivan Rilsky University Hospital, Sofia, Bulgaria;
Krasimir Antonov; Clinic of Gastroenterology, St. Ivan Rilsky University Hospital, Sofia, Bulgaria;
Zahariy Krastev; Clinic of Gastroenterology, St. Ivan Rilsky University Hospital, Sofia, Bulgaria;