AB0699 Prevalence of systemic lupus erythematosus in autoimmune hepatitis

Background Autoimmune hepatitis (AIH) is a necrotico-inflammatory chronic disease of the liver of unknown etiology. It is associated in approximately 40% of cases with at least another auto-immune disease in particular Sjogren Syndrome and auto-immune thyroid dysfunction. The association AIH-systemic lupus erythematosus (SLE) was rarely reported in literature. Objectives To evaluate the prevalence of SLE in AIH and to determinate the characteristics of this association. Methods A retrospective study including all patients affected by AIH, hospitalised in the Department of Gastroenterology B of Rabta’s Hospital between January 1996 and December 2009. We have searched among those patients the SLE cases; diagnosis retained basing on ACR criteria (American College of Rheumatology). Results During the period of the study, 34 cases of AIH were collected. There were 29 women and 5 men with a mean age of 46 years. The association with a SLE was noted in 3 cases (8,8%). There were 3 women aged respectively by 15, 66 and 47 years. The hepathopathy was at the stage of cirrhosis with ascites in the first 2 cases and at a stage of chronic hepatitis revealed by an acute cytolysis (50- fold above the normal values) in the last case. The immunological tests showed antinuclear antibodies (AAN) positivity in all cases and the presence of anti-smooth muscle antibodies specific of actine in the 1st and the 3rd patients. Native anti-DNA antibodies were noted in all cases. In all patients, the diagnosis of SLE was retained basing on the positivity of both antinuclear and native anti-DNA antibodies associated in the 1st case with a photosensitivity and a haemolytic anaemia, in the 2nd case with a polyserosits and a severe renal failure and in the 3rd case, with the presence in immunofluorescence of C1q, C3 and IgG deposits on the dermo-epidermal junction. Besides, celiac disease and autoimmune hypothyroidism were diagnosed respectively in the 1st and the 3rd patient. A corticosteroid therapy was undergone in the 2nd and the 3rd patients and was associated with azathioprine (AZT) in the 3rd case which was quickly stopped in front of the appearance at the ninth day of an acute pancreatitis. Conclusions AIH and SLE association is rare. Its systematic research by an immunological assessment in the presence of AIH could help to early diagnosis. Disclosure of Interest None Declared