Severe Acute Cholera Infection Mimicking Decompensated Liver Cirrhosis and Triggering Autoimmune Hepatitis.
Hind I Fallatah, Reham Kaki, Tariq Ahmed Madani
✦ AI-curated · Sources linked
Case in brief
An 18-year-old previously healthy Sudanese refugee developed severe acute cholera with deep cholestatic jaundice, disseminated intravascular coagulation, hemolysis, hepatic encephalopathy, and ascites. Initial imaging and transient elastography suggested decompensated cirrhosis. Progressive transaminitis with persistent hyperbilirubinemia followed, and antinuclear and smooth muscle antibodies supported infection-triggered autoimmune hepatitis. Prednisolone produced a marked response, with azathioprine later added as a steroid-sparing agent. Two relapses occurred after treatment was stopped. After biochemical remission, liver stiffness on FibroScan normalized.
What made this case unusual
Severe cholera initially mimicked decompensated cirrhosis on imaging and elastography, followed by the development of autoimmune hepatitis; the normalized liver stiffness after remission highlights the potential for acute inflammatory disease to distort these assessments.
Diagnostic / clinical pearl
In severe acute infection, cholestasis and abnormal imaging or elastography may mimic cirrhosis; evolving transaminitis and autoimmune serology can reveal a subsequent autoimmune hepatitis.
Why it matters
The reported relapses after treatment discontinuation underscore the importance of follow-up in this patient with a chronic relapsing course.