Duaa Ahmed Yousif Abduljabbar
Department of Internal Medicine; King Hamad University Hospital in Kingdom of Bahrain, Bahrain
Biography
Dr Duaa Abduljabbar has completed her medical degree from Arabian Gulf university in the Kingdom of Bahrain in 2013. She is currently completing her final year in the Saudi Board residency program. She has completed part A and B in Membership of the Royal Collage of Physicians (MRCP). Currenlty she is working as a senior resident in internal medicine department in King Hamad University Hospital.
Abstract
A 14-year-old female presented to the gastroenterology clinic due to incidental finding of deranged liver function tests.
She is a known case of diabetes mellitus (DM) and hypothyroidism on treatment since 5 years with lantus 38 units at night , novorapid 20 units with meals, and levothyroxine 100 mcg daily.
The diagnosis of autoimmune hepatitis was made based on hepatocellular picture in liver enzymes elevation (ALP 377 , ALT 424 , AST 451 and GGT 118), ESR 63 mm/hr, ANA positive centromere pattern 191 u/ml, Anti smooth muscle antibody 640 , immunoglobulin G 3945 mg/dL. However Anti liver-Kidney microsomal antibody was in insignificant level.
Abdominal US showed coarse hepatic echotexture having stippled pattern with increased periportal echogenicity, with possibility of hepatitis.
A review of her diagnosed DM and hypothyroidism with further investigations was done and showed uncontrolled type 1DM confirmed by high HbA1C , and seropositivity towards anti-glutamic acid decarboxylase (332 IU/ml, 6+++).
Immune thyroid disease diagnoses was made based on positive antithyroid peroxidase antibody of >1300 u/ml, at the time thyroid function tests were normal as patient was already of treatment.
The case showed rare combination of three distinct autoimmune disases starting at young age. The patient was followed regularly in the clinic, the condition improved with normalization of LFT with the use of steroids and immunosuppression.