"Lupoid" Hepatitis, a Nonentity in the Spectrum of Chronic Active Liver Disease

Abstract

The hypothesis that lupoid hepatitis represents a specific entity in the range of chronic active liver diseases was tested by examining the clinical, biochemical, immunochemical, and histologic features of 88 consecutive patients with chronic active liver disease. All patients were selected by predefined criteria and regardless of the result of the lupus erythematosus (LE) test. Initially, the test was positive in 30 patients and negative in 58 patients. LE-positive patients were characterized by disease of shorter duration before symptoms developed and more frequent hepatosplenomegaly; higher levels of serum bilirubin, γ-globulin, and IgG; longer prothrombin time; and lower levels of serum albumin. The incidence of subacute hepatitis with bridging was greater in LE-positive patients. In contrast, the two groups could not be differentiated by sex, age, associated disease of an autoimmune type, most systemic manifestations of liver disease, responses to treatment, the presence of smooth muscle antibody, antinuclear antibody, or Australia antigen, and the degree of plasma cell infiltration on liver biopsy. The LE cell test became negative in 92% of those who responded to treatment, but in none who failed to respond. Discriminant analysis of numerous variables failed to distinguish characteristic features associated with the LE test in most patients. The data are interpreted as showing that a positive LE test indicates more active and severe liver disease rather than a different entity with a specific cause or prognosis.