Clinical characteristics of fulminant‐type autoimmune hepatitis: an analysis of eleven cases

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Abstract
Summary: Background: Although a few adult cases of fulminant‐type autoimmune hepatitis have been reported, their clinical features and prognosis have remained uncertain.Aim: To assess the clinical features and prognosis of patients with fulminant‐type autoimmune hepatitis.Methods: Eleven patients (10%) diagnosed with fulminant‐type autoimmune hepatitis in accordance with the 1999 criteria of the International Autoimmune Hepatitis Group were analysed.Results: All 11 patients were female, with a median age of 53 years. Five patients survived without liver transplantation, one received a liver transplantation, and five died without liver transplantation. Nine patients (82%) survived for 2 weeks or more following diagnosis, without liver transplantation. Except for the patient receiving a liver transplantation, serum total bilirubin levels measured during the clinical course were significantly higher in non‐survivors than in survivors, although the accompanying serum alanine aminotransferase levels measured for the two groups were similar. Most significantly, serum total bilirubin levels in non‐survivors worsened during days 8–15, while levels in survivors improved during the same period.Conclusions: The short‐term prognosis for patients with fulminant‐type autoimmune hepatitis may be good. However, patients whose serum total bilirubin levels worsen during days 8–15 should be considered for liver transplantation.