29 June 2022
: Case report 
Acute Hepatitis with Positive Autoantibodies: A Case of Natalizumab-Induced Early-Onset Liver Injury
Unusual clinical course, Challenging differential diagnosis, Unusual or unexpected effect of treatment, Diagnostic / therapeutic accidents, Unexpected drug reaction, Educational Purpose (only if useful for a systematic review or synthesis)
Marlone Cunha-Silva
1ABCDEF*, Priscilla Brito Sena de Moraes 1ABCDEF, Pedro Rodrigues de Carvalho 2ABEF, Larissa Bastos Eloy da Costa 3BDEF, Guilherme Rossi Assis-Mendonça 3BCE, Cristina Alba Lalli 2BCE, Gisele Conte Alves Fernandes 1BCDE, Fernanda Bocchi Monteiro 1BDE, Gustavo Manginelli Lamas 4BEF, Alfredo Damasceno 4BDE, Daniel Ferraz de Campos Mazo 1CDF, Tiago Sevá-Pereira 1DF
DOI: 10.12659/AJCR.936318
Am J Case Rep 2022; 23:e936318
Table 1. Initial laboratory tests.
| Blood tests | Patient | Normal range | Immunology | |
|---|---|---|---|---|
| Hemoglobin | 15.8 | 12–16 g/dL | HBsAg | Negative |
| Leucocytes | 11 630 | 4000–10 000/mm | Anti-HBc | Negative |
| Platelets | 154 000 | 150 000–400 000/mm | Anti-HBs | Negative |
| ALT | 1151 | <35 U/L | Anti-HAV IgG | Positive |
| AST | 1790 | <35 U/L | Anti-HAV IgM | Negative |
| AP | 315 | <104 U/L | Anti-HCV | Negative |
| GGT | 151 | <40 U/L | Anti-HIV | Negative |
| Total bilirubin | 35.9 | 0.3–1.2 mg/dL | Cytomegalovirus IgG | Positive |
| Direct bilirubin | 26.5 | <0.2 mg/dL | Cytomegalovirus IgM | Negative |
| Albumin | 3.1 | 3.5–5.2 g/dL | Syphilis | Negative |
| INR | 1.27 | <1.25 | Epstein-Barr virus IgM | Negative |
| Urea | 17 | 17–43 mg/dL | Anti-smooth muscle AB | 1: 40 |
| Creatinine | 1.0 | <0.9 mg/dL | Anti-mitochondrial AB | Negative |
| IgG | 552 | 950–1500 mg/dL | Anti-nuclear AB | 1: 80 |
| Ceruloplasmin | 45 | 20–60 mg/dL | RT-PCR-SARS-CoV-2 | Negative |
| ALT – alanine aminotransferase; AST – aspartate aminotransferase; AP – alkaline phosphatase; GGT – gamma-glutamyl transferase; INR – international normalized ratio; IgG – immunoglobulin G; IgM – immunoglobulin M; HAV – hepatitis A virus; HCV – hepatitis C virus; HIV – human immunodeficiency virus; AB – antibody; RT-PCR-SARS-CoV-2 – reverse transcriptase-polymerase chain reaction test for severe acute respiratory syndrome coronavirus 2. | ||||