PATIENT DETAILS:

Name: Anam Zulfiqar Ali Age: 21 Years Gender: Female

Anam Zulfiqar Ali, 21-year-old female, known case of Grave’s Disease (underwent sub-total
thyroidectomy), and DM Type 1 (since 2001), presented to Shaikh Zayed Hospital on 10th February 2017
with jaundice, easy fatigability, generalized itchiness, RLQ abdominal pain, abnormal LFTs of 41 days’
duration. Bilirubin at the time of presentation was 13.4 mg/DL. She underwent following blood
investigations after admission:

▪ ANA, AMA, ASMS – negative

▪ Hep B S Ag – Non-reactive
▪ Qualitative HCV PCR – RNA not detected
▪ Serum Hep E IgM Antibody – Non-reactive
▪ Anti LKM-1 IgG – negative
▪ Serum Ceruloplasmin – negative
▪ Serum copper – negative
▪ Urinary copper – within range

She had been taking Ursofalk tablets since 8th February (prior to admission). Diagnosis of
Autoimmune Hepatitis was made taking into consideration the biopsy reports (presence of plasma
cells); results of blood tests mentioned above,extended autoimmune liver profile – which was
positive for anti LC-1 antibody (12 AU +) (tested on 10th March), and Serum IgG levels (tested on
15th March).

Result interpretation for anti LC-1 antibody: Serum IgG (900-1600):

treatment
After beginning
➢ Negative – 0-5 AU * 15/3 - 3658
➢ Borderline (+) - 6-10 AU * 02/5 - 2180
➢ Positive (+) - 11-25 AU * 06/6 - 2455
➢ Positive (++) – 26-50 AU * 06/7 - 2445
➢ Strong positive - 50 AU * 22/7 - 2571

Treatment for the same was started on 19th February, with the following medications:

❖ Methylprednisolone (Deltacortil) – 30 mg once daily

❖ Azathioprine (Immuran) – 50 mg once daily
❖ Esomeprazole (Risek) – 40 mg once daily
❖ Qalsan – D (calcium supplement) – once daily

Following treatment, bilirubin levels decreased and subsequent LFTs had improvements.

DATE BILIRUBIN (0.1 – 1.0) CONJ. BILIRUBIN (0.1– 0.5) AST (0-33) ALT (0-34) ALP (35-104)
treatment

31-12-16 1.3 0.86 800 1000 140

Prior to

18-01-17 5.9 5.06 1612.7 1328.9 205

01-02-17 13.4 11.28 2126.0 1321.0 150
24-02-17 14.1 10.3 467 329 116
25-02-17 13.89 8.59 472 349 148
DATE BILIRUBIN (0.1 – 1.0) CONJ. BILIRUBIN (0.1– 0.5) AST (0-33) ALT (0-34) ALP (35-104)
02-03-17 14.4 8.71 288 312 174
08-03-17 14.4 10.7 482 433 150
09-03-17 11.3 570 400 360
22-03-17 8.9 8.3 390 342 529
11-04-17 5.1 4.6 72.7 77.3 147
02-05-17 2.9 2.1 66.0 66.6 132
10-05-17 2.1 1.8 46.5 40.3 119
06-06-17 1.2 1.00 81.6 82.7 111
06-07-17 0.9 0.6 50.3 41.5 90

The dose for methylprednisolone was tapered slowly, following 41 days of treatment from the time of
starting medications, as follows:

❖ 30 mg (6 tablets) – for 1 week (from 29/03 – 05/04)

❖ 25 mg (5 tablets) – for 1 week (from 05/04 – 12/04)
❖ 20 mg (4 tablets) – for 1 week (from 12/04 – 19/04)
❖ 15 mg (3 tablets) – for 1 week (from 19/04 –26 /04)
❖ 10 mg (2 tablets) – henceforth (from 29/04 – Present)

At present, no scleral icterus, no yellowish skin discoloration, no pedal edema

Medications at present:

▪ Deltacortil 10 mg
▪ Immuran 50 mg
▪ Risek – 40mg
▪ Ursofalk – 2x/daily
▪ Qalsan – D
▪ Levothyroxine
▪ Insulin (Lantus & Actrapid)