The Prevalence of True Non-Alcoholic Steatohepatitis (NASH) in Patients Presenting with Autoimmune Hepatitis (AIH) and Pericellular Trichrome Staining, a Potential Mimicker of NASH in Active AIH
Javier De Luca-Johnson, Taka Ashikaga, Edward Krawitt, Rebecca Wilcox. University of Vermont Medical School (UVM), Burlington, VT; UVM, Burlington, VT
Background: Given the increasing burden of NASH in the general population, a similar rise might be expected in AIH patients. This is a clinical concern as AIH treatment can exacerbate NASH. We sought to determine the prevalence of NASH in pts presenting with AIH and to document their clinical and histologic findings.
Design: We identified all AIH cases at our institution in the last 35 yrs. with documenation of age, gender, comorbidities(DM, hyperlipidemia, obesity, HTN), alcohol abuse, lab data(auto-Abs,Igs,HBV/HCV serologies) and history of steroid response. Only cases meeting 2008 simplified Autoimmune Hepatitis Group(AHG) criteria were accepted as AIH. These biopsies were further evaluated for Grade/Stage(Batts-Ludwig), steatosis, and NASH(Brunt). Statistical analysis used point estimates supplemented with exact 95% confidence intervals. Associations between NASH and other conditions were assessed using contingency table methods.
Results: Of the database pts(n=127) 73 (Age 11-78;mean 50:62% female) met AHG criteria for AIH. Overall prevalence of NASH at AIH diagnostic biopsy was 16.4%(12 of 73;CI 8.8-27%). An additional 15% had steatosis. The only comorbidities significantly association with NASH were type 2 diabetes(p=0.059) and older age(p=0.043). 19 of the 73 biopsies had “NASH-like” features without meeting criteria for NASH:5 had pericellular trichrome staining(PCTS) and 14 had PCTS directly associated with ballooned hepatocytes(Fig 1). The PCTS was focal/non-zonal and paler compared to portal tract fibrosis. Reticulin highlighted collapse in these foci(insert).
Conclusions: The prevalence of NASH in pts presenting with AIH was 16.4%. In addition, 26% of our AIH diagnostic biopsies displayed a “NASH-like” feature of PCTS often associated with ballooning. Although most consistent with necrosis/parenchymal collapse secondary to active AIH, this finding has the potential to be misinterpreted as NASH, particularly in the presence of steatosis. Attention to strict NASH criteria and examination of reticulin stain was essential in making this distinction.
Monday, March 4, 2013 2:30 PM
Proffered Papers: Section E, Monday Afternoon