Post-Infantile Giant Cell Hepatitis Associated with Rheumatoid Arthritis

Abstract

Background Post-infantile giant cell hepatitis (PIGCH), also known as syncytial giant cell hepatitis, although a common finding in pediatric cases, continues to be ill-defined with rare disease presentation in the adult population. There have only been 100 reported cases in the last 30 years. Post-infantile giant cell hepatitis is predominantly a histopathological diagnosis, necessitating a tissue sample for the visualization of characteristic giant cell hepatocyte transformation. There is limited literature on the disease process, causes, and treatment success of post-infantile giant cell hepatitis in adults. Case Presentation A 41-year-old female with a past medical history of rheumatoid arthritis presented to her gastroenterologist for iron deficiency anemia evaluation and was found to have elevated liver enzymes (AST/ALT). She was asymptomatic with the exception of weight loss. Colonoscopy and fibroscan were non-specific. A subsequent liver biopsy revealed hepatocyte syncytial giant cell change. The correlation of the clinical presentation and histopathology confirmed the diagnosis of post-infantile giant cell hepatitis secondary to rheumatoid arthritis. Interestingly, the patient’s autoimmune hepatitis workup and infectious disease panel were negative. A literature review identified only one case of post-infantile giant cell hepatitis as a secondary manifestation of rheumatoid arthritis. The patient was placed on ursodeoxycholic acid, prednisone, and furosemide, and is currently being managed by hepatology. Discussion Our case report aims to bring forth a vignette of post-infantile giant cell hepatitis to spotlight this ill-defined disease and highlight some of the proposed causes, treatments, and laboratory markers. Post-infantile giant cell hepatitis is thought to be a secondary manifestation of other disease processes, including viral, autoimmune, hematologic, or drug-induced injury. It can also be idiopathic in nature. Management of PIGCH largely depends on the underlying mechanisms; thus, treatment is patient-specific. Our case showing PIGCH’s association with rheumatoid arthritis provides valuable insight into the future diagnosis, treatment, and understanding of this rare disease and its association with autoimmune diseases in adult populations.