Abdominal Pain as the Initial Symptom of Autoimmune Hepatitis with Thymoma, a Misdiagnosed Case Report and Literature Review

ZHAO Song-quiz; BAN Yu; MENG Qing-yi

doi:10.3969/j.issn.1002-3429.2015.06.0010

Abstract：Objective To investigate the clinical features and experience about the autoimmune hepatitis (AIH). Methods A retrospective analysis of a misdiagnosed case with autoimmune hepatitis was carried out. Results The patient suffered from abdominal pain for 13 days, and had been misdiagnosed as stomach cramps, gastritis, peritonitis, after treatment to relieve pain failed. No previous history of long-term heavy alcohol consumption and long-term liver damaging medication were recorded. The abdominal ultrasound showed solid echo diffuse thickening of liver, splenomegaly and ascites. Liver func-tion, hepatitis B, hepatitis C and hepatitis E virus related examinations were normal. Antinuclear antibody ( ANA) test was positive(1∶ 1000, particles), anti-mitochondrial antibody ( AMA) test was negative, and anti-smooth muscle antibodies ( ASMA) test was negative. Liver biopsy showed partial liver cell proliferation and cloudy swelling, small bile duct structure, and periportal fibrosis with chronic inflammatory cell infiltration. According to AIH diagnostic scoring system, the patient was diagnosed with autoimmune hepatitis. The lung CT scan showed pulmonary nodules on the anterior mediastinum, and the pos-sibility of a large thymoma was suspected. The pain was relieved after immunosuppressant. The abdominal symptoms disap-peared completely in the 3-month-follow-up. Thymoma may need further surgical treatment. Conclusion If the conventional treatment does not relieve the abdominal pain in hepatic cirrhosis patients, autoimmune hepatitis should be considered and Im-munologic test, antisubstance and liver biopsy should be taken to prevent misdiagnosis.