PMC4723101_01
Liver associated enzymes rapidly improve following initiation of anti-inflammatory therapy in a HIV-infected patient with autoimmune hepatitis and primary biliary cirrhosis overlap syndrome.
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F1
HIV infection on antiretroviral therapy (ART) presented to the National Institutes of Health (NIH) from a community health center in Washington, DC, for further evaluation of elevated LAEs. Her baseline CD4 cell count was 420 cells/mm3 and her LAEs were normal prior to starting ART (Figure 1). Screening laboratories showed elevation in her LAEs with AST 244 U/L, ALT 287 U/L, AP of 659 U/L, and gamma glutamyl transferase (GGT) of 607 U/L (Figure 1). Her LAEs improved over the next year (Figure 1).
Left: Portal area showing marked chronic inflammation with numerous plasma cells and ductular reaction. Inset shows hepatocytes with a positive staining reaction for copper, indicative of chronic cholestasis. (H&E,x 200; inset: Copper stain, x 600). Right: Cytokeratin 7 stain showing infiltration of a bile duct by lymphocytes (arrow). Ductular reaction is present at the edges of the portal area (CK7 antibody, x400).
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F2
Percutaneous liver biopsy showed chronic cholestatic liver disease with marked inflammatory activity, bile duct injury, and periportal and perivenular fibrosis consistent with primary biliary cirrhosis (Figure 2).