PMC7332635_01
Computed tomography revealed no mass lesions, stones or biliary duct dilatation.
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Computed tomography and magnetic resonance cholangiopancreatography revealed no mass lesions, stones or biliary duct dilatation (Fig. 1).
a, b: A needle liver biopsy specimen showing interface hepatitis with mainly lymphocytic infiltration and occasional bridging fibrosis in the periportal area, indicating chronic active hepatitis due to AIH (Hematoxylin and Eosin staining, a: x100, b: x400). c: Immunohistochemistry showing lymphocytic infiltration lymphocytic infiltration that was positive for IgG4 (140 cells per high-powered field) with an IgG4/IgG-positive cell ratio of 60%, which suggested the IgG4-related type. AIH: autoimmune hepatitis
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A needle liver biopsy specimen showed interface hepatitis with mainly lymphocytic infiltration and occasional bridging fibrosis in the periportal area, indicating chronic active hepatitis due to AIH (Fig. 2a, b). IgG4 [140 cells per high-powered field (HPF)] with an IgG4/IgG-positive cell ratio of 60%, which suggested the IgG4-related type (Fig. 2c). In contrast, the DDW-J2004 DILI workshop score for benidipine was 'probable' (score 7), although the patient refused to undergo a drug lymphocyte stimulation test.
Clinical course. AST: aspartate aminotransferase, ALT: alanine aminotransferase, gamma-GTP: gamma-glutamyl transpeptidase, PSL: prednisolone, UDCA: ursodeoxycholic acid
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The patient has sustained remission since then (Fig. 3).