S4196 Autoimmune Hepatitis Uncovered Following Locally Acquired Dengue Infection

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Introduction: Autoimmune hepatitis is a chronic inflammatory disorder of the liver marked by elevated aminotransferases, hypergammaglobulinemia, and the presence of serological autoantibodies. Dengue is the most widespread arbovirus causing the highest number of arboviral disease cases in the Americas. It is endemic in most countries of South and Central America and the Caribbean. Dengue is becoming more prevalent, with cumulative cases in the second half of 2023 surpassing all previous yearly totals and extending beyond historically affected areas of transmission despite not being endemic to the US. We present a case of autoimmune hepatitis discovered in a patient with locally acquired dengue in Broward County. Case Description/Methods: A 39-year-old woman with no medical history presented with 2 weeks of malaise, subjective fevers, abdominal pain, rhinorrhea, dry cough, and a diffuse erythematous blanching rash on her trunk and extremities. Laboratory results were remarkable for thrombocytopenia and an elevated aspartate aminotransferase. Initial infectious disease workup was negative for: hepatitis, human immunodeficiency virus, rapid plasma reagin, respiratory viral panel, antistreptolysin O titers, and influenza. She developed persistent transaminitis and thrombocytopenia which warranted further gastroenterology, infectious disease, and autoimmune workup. Dengue virus immunoglobulin M antibody was found to be positive despite no recent travel abroad with antinuclear antibodies and anti-smooth muscle antibody also found to be positive. Liver ultrasound and magnetic resonance cholangiopancreatography were unremarkable. Liver biopsy revealed moderate portal chronic inflammation without evidence of fibrosis. She was given intravenous fluids and steroids with eventual resolution of her transaminitis and thrombocytopenia. Discussion: Acute dengue infection has been known to cause transaminitis. At first glance, her transaminitis could have initially been attributed to dengue hepatitis but further investigation confirmed findings consistent with autoimmune hepatitis. Some studies have suggested autoimmunity might occur after dengue infection and even cause some autoimmune diseases. It is unclear whether the patient had an underlying autoimmune condition that was unmasked by dengue or whether dengue resulted in autoimmune hepatitis. This case highlights the association between autoimmune conditions and dengue infection. This was the first and only case of locally acquired dengue in Broward County in 2023.

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