Colangite auto-imune – a propósito de um caso clínico
Palavras-chave:
Colangite auto-imune, cirrose biliar primária, hepatite auto-imune, anticorpos anti-mitoncondriais, anticorpos anti-músculo liso, gama-glutamiltransferase, fosfatase alcalinaResumo
Os autores apresentam o caso de uma doente de 45 anos,
previamente saudável e assintomática, que foi enviada à
consulta de Medicina Interna para estudo de elevação das
provas hepáticas (fosfatase alcalina, gama-glutamiltransferase
e transaminases) diagnosticada em análises de rotina. Não
apresentava alterações ao exame objectivo e do estudo
complementar que se seguiu destacam-se anticorpos antimitoncondriais e anti-nucleares negativos e anticorpos antimúsculo liso positivos. A biópsia hepática revelou lesão do
ducto biliar, apoiando o diagnóstico de colangite auto-imune.
Faz-se uma breve revisão sobre esta entidade patológica, ainda
envolta em alguma polémica.
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Referências
Beuers U, Rust C. Overlap Syndromes. Semin Liver Dis. 2005; 25(3):311-320. www.medscape.com/viewarticle/512463
Heathcote J. JAASLD guidelines: Management of primary biliary cirrhosis. Hepatology 2000; 31:1005-1013.
Brunner G, Klinge O. A chronic destructive non-supurative cholangitis-like disease picture with antinuclear antibodies (immunocholangitis). Deutsch Med Wochenschr 1987; 112:1454-1458.
Datta D, Sherlock S, Scheuer P. Post-necrotic cirrhosis with chronic cholestasis. Gut 1963; 4:223-230.
Okuno T, Seto Y, Okanoue T, Takino T. Chronic active hepatitis with histological features of primary biliary cirrhosis. Dig Dis Sci 1987;32:775-779.
Bonis P, Krawitt E. Definition and treatment of variants of autoimmune hepatitis. UptoDate 15.1. www.UptoDate.com
Czaja A, Freese D. Diagnosis and treatment of autoimmune hepatitis. Hepatology 2002; 36:147-497.
Heathcote J. Autoimmune cholangitis. Gut 1997; 10:440-442.
Michieletti P, Wanless I, Katz A et al. Antimitochondrial antibody negative primary biliary cirrhosis: a distinct syndrome of autoimmune cholangitis. Gut 1994; 35:260-265.
Taylor S, Dean P, Riely. Primary autoimmune cholangitis. An alternative to antimitochondrial antibody-negative primary biliary cirrhosis. Am J Surg Pathol 1994; 18:91-99.
Ohana M, Okasaki K, Hajiro K, Uchida K. Antilactoferrin antibodies in autoimmune liver diseases. Am J Gastroenterol 1998; 93:1334-1339.
Kinoshita H, Omagari K, Whittinngham S et al. Autoimmune cholangitis and primary biliary cirrhosis – an autoimmune enigma. Liver 1999; 19:122-128.
Gordon S, Quatrociocchi-Longe T, Khan B et al. Antibodies to carbonic anhydrase in patients with immune cholangiopathies. Gastroenterology 1995; 108:1808-1809.
Goodman ZD, McNally P, Davis D, Ishak K. Autoimmune cholangitis: a variant of primary biliary cirrhosis. Clinicopathologic and serologic correlations in 200 cases. Dig Dis Sci 1995; 40:1232-1242.
Omagari K, Ikuno N, Matsuo I et al. Autoimmune cholangitis syndrome with a bias towards primary biliary cirrhosis. Pathology 1996, 28:255-258.
Miyakawa H, Tanaka A, Kikuchi K et al. Detection of antimitochondrial autoantibodies in immunofluorescent AMA-negative patients with primary biliary cirrhosis using recombinant autoantigens. Hepatology 2001; 34:243-248.
Ikuno N, Scealy M, Davies J et al. A comparative study of antibody expressions in primary biliary cirrhosis and autoimmune cholangitis using phage display. Hepatology 2001; 34: 478-486.
Ben-Ari Z, Dhillon A, Sherlock S. Autoimmune cholangiopathy: part of the spectrum of autoimmune chronic active hepatitis. Hepatology 1993; 18:10-15.
Chazouillères O, Wendum D, Serfaty L et al. Primary biliary cirrhosis autoimmune hepatitis overlap syndrome: clinical features and response to therapy. Hepatology 1998; 28:296-301.
Czaja A, Carpenter H, Santrach P, Moore S. Autoimmune cholangitis within the spectrum of autoimmune liver disease. Hepatology 2000. 31:1231-1238.
Kim W, Poterusha J, Jorgensen R et al. Does antimitochondrial antibody status affect response to treatment in patients with primary biliary cirrhosis? Outcomes of ursodeoxycholic acid therapy and liver transplantation. Hepatology 1997; 26:22-26.
Joshi S, Couch-Dudek K, Wanless I et al. Primary biliary cirrhosis with additional features of autoimmune hepatitis: response to therapy with ursodeoxycholic acid. Hepatology 2002; 35:409-413.
Terracciano L, Patzina R, Lehman F et al. A spectrum of histophatologic findings in autoimmune liver disease. Am J Clin Pathol 2000; 114 (5):705-711.
Chazouillères O, Wendum D, Serfaty L et al. Long term outcome and response to therapy of primary biliary cirrhosis-autoimmune hepatitis overlap syndrome. J Hepatol 2006; 44:400-406.
Findor J, Sorda J, Daruich J, Manero E. Familial Association in Autoimmune Liver Disease. Medicina 2002; 62: 241-244.
Juran B, Atkinson E, Schlicht E, Fridley B, Lazaridis K. Primary Biliary Cirrhosis is Associated With a Genetic Variant in the 3’ Flanking Region of the CTLA4 Gene. Gastroenterology 2008; 135(4); 1200-1206.
Vaidya B, Pearce. The Emerging Role of the CLTA-4 Gene in Autoimmune Endocrinopathies. European Journal of Endocrinology 2004; 150: 619-626
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Este trabalho encontra-se publicado com a Licença Internacional Creative Commons Atribuição 4.0.
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