Giant cell hepatitis with autoimmune hemolytic anemia in early childhood: Long-term outcome in 16 children

Giuseppe Maggiore, Marco Sciveres, Monique Fabre, Laura Gori, Lucia Pacifico, Massimo Resti, Jean Jacques Choulot, Emmanuel Jacquemin, Olivier Bernard

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To assess the outcome of giant cell hepatitis combined with autoimmune hemolytic anemia in early childhood. Study design: We report on 16 children with this disease evaluated over a 28-year period. Results: Children (nine boys; median age, 6 months) presented with jaundice, hepatomegaly, elevated aminotransferases, a positive Coombs test, and diffuse giant-cell transformation of hepatocytes on histology. Treatment with prednisone and azathioprine, plus, in three children, cyclosporine, resulted in complete remission in eight, partial remission in six, and failure in two. Relapses of hepatitis and/or anemia occurred in 11 and 10 children, respectively, requiring prolonged high levels of immunosuppression, and splenectomy or Rituximab, respectively. Treatment was stopped after a mean duration of 6 years, with no relapse, in seven children, with a median follow-up of 14 years. One child is alive 9 years after liver transplantation. Four children died of sepsis or multiple organ failure. Conclusions: Giant cell hepatitis combined with autoimmune hemolytic anemia requires rigorous treatment. Immunosuppressive therapy results in remission in most cases. A complete cure can be expected after several years of intensive treatment. Liver transplantation may be associated with prolonged survival.

Original languageEnglish
JournalJournal of Pediatrics
Volume159
Issue number1
DOIs
Publication statusPublished - Jul 2011

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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