Alopecia after autoimmune hepatitis: case report

Abstract

Background: Patients with autoimmune hepatitis may have an increased risk of developing other autoimmune diseases, such as alopecia areata. Most of the extrahepatic manifestations of autoimmune hepatitis are known, but the exact number of patients affected by skin disorders is little discussed, and such manifestations are generally overlooked or underreported.

Aim: To report a case of alopecia following autoimmune hepatitis seen in our department.

Method: This was a 13-year-old patient seen at the Pediatrics Department of the Hospital Universitário São Francisco na Providência de Deus - HUSF, located in the city of Bragança Paulista – SP, Brazil.

Case Report: This report describes the case of a 13-year-old patient who was initially admitted with progressing jaundice, which began in the ocular conjunctiva and progressed to the whole body, presenting with dyspnea, fatigue, edema, ascites and abdominal pain. Tests revealed chronic liver disease, pneumonia, pleural and pericardial effusion, as well as splenomegaly and probable vesicular lithiasis. The patient was treated with antibiotics, diuretics and vitamin K. Her breathing improved, but ascites and jaundice remained. She was later diagnosed with autoimmune hepatitis and, after being discharged from hospital, developed total alopecia. She was then started on corticosteroid therapy with clinical improvement, and is currently on continuous treatment with tacrolimus, prednisone and vitamin D, with no indication for liver transplantation, despite the fact that her symptoms have not completely gone into remission.

Conclusion: This clinical case highlights the complexity of diagnosing and managing autoimmune hepatitis in a pediatric patient, who initially presented with jaundice and nonspecific symptoms that evolved into a more severe condition with ascites and respiratory involvement. The combination of laboratory and imaging tests was crucial for the identification of chronic hepatopathy, culminating in the final diagnosis based on autoimmune markers. The response to treatment with corticotherapy was positive, highlighting the importance of early intervention, although the patient developed alopecia as a complication. The case highlights the importance of continuous follow-up, since, despite clinical improvement and the absence of an immediate need for liver transplantation, the patient remains without complete remission of symptoms. This report underlines the need for multidisciplinary approaches and prolonged surveillance in the management of pediatric autoimmune diseases.