{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T06:40:05Z","timestamp":1756363205943,"version":"3.44.0"},"reference-count":19,"publisher":"BMJ","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BMJ Case Reports"],"abstract":"<jats:p>A 48-year-old woman with systemic lupus erythematosus diagnosis was on naproxen, hidroxichloroquine and acetylsalicylic acid. She had self-suspended all medication and resumed 1\u2005year later. Five days after the medication was resumed, she developed acute hepatitis, with biochemical hepatic cytolysis, hypergamaglobulinaemia and a serum antinuclear antibody titre of 1\/2560. Idiopathic autoimmune hepatitis was considered, but drug-induced liver injury could not definitely be ruled out. Patient declined liver biopsy. Oral prednisolone was started. Within 3\u2005months with prednisolone being tapered to 10\u2005mg\/day, a new flare occurred. Liver biopsy was performed and it favoured autoimmune hepatitis diagnosis. We discuss the diagnostic options and treatment approach in a patient with autoimmune disease and possible drug-induced liver injury who initially declined liver biopsy.<\/jats:p>","DOI":"10.1136\/bcr-2013-008591","type":"journal-article","created":{"date-parts":[[2013,4,6]],"date-time":"2013-04-06T00:32:32Z","timestamp":1365208352000},"page":"bcr2013008591","source":"Crossref","is-referenced-by-count":0,"title":["Acute hepatitis in a young woman with systemic lupus erythematosus: a diagnostic challenge"],"prefix":"10.1136","volume":"2013","author":[{"given":"Rita","family":"Barosa","sequence":"first","affiliation":[{"name":"Department of Gastrenterology, Hospital Garcia de Orta, Almada, Portugal"}]},{"given":"L\u00eddia Roque","family":"Ramos","sequence":"additional","affiliation":[{"name":"Department of Gastrenterology, Hospital Garcia de Orta, Almada, Portugal"}]},{"given":"Cristina","family":"Fonseca","sequence":"additional","affiliation":[{"name":"Department of Gastrenterology, Hospital Garcia de Orta, Almada, Portugal"}]},{"given":"Jo\u00e3o","family":"Freitas","sequence":"additional","affiliation":[{"name":"Department of Gastrenterology, Hospital Garcia de Orta, Almada, Portugal"}]}],"member":"239","published-online":{"date-parts":[[2013,4,5]]},"reference":[{"key":"2025082723083065000_2013.apr05_1.bcr2013008591.1","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1007\/s11894-008-0023-x","article-title":"Epidemiology of acute liver failure","volume":"2013","author":"Khashab","year":"2007","journal-title":"Curr Gastroenterol Rep"},{"key":"2025082723083065000_2013.apr05_1.bcr2013008591.2","doi-asserted-by":"crossref","first-page":"1271","DOI":"10.1002\/art.1780251101","article-title":"The 1982 revised criteria for the classification of systemic lupus erythematosus","volume":"2013","author":"Tan","year":"1982","journal-title":"Arthritis Rheum"},{"key":"2025082723083065000_2013.apr05_1.bcr2013008591.3","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1586\/egh.09.15","article-title":"Current and future treatments of autoimmune hepatitis","volume":"2013","author":"Czaja","year":"2009","journal-title":"Expert Rev Gastroenterol Hepatol"},{"key":"2025082723083065000_2013.apr05_1.bcr2013008591.4","doi-asserted-by":"crossref","first-page":"1237","DOI":"10.4065\/76.12.1237","article-title":"Current concepts in diagnosis, pathogenesis and treatment of autoimmune hepatitis","volume":"2013","author":"Al-Khalidi","year":"2001","journal-title":"Mayo Clin Proc"},{"key":"2025082723083065000_2013.apr05_1.bcr2013008591.5","doi-asserted-by":"crossref","first-page":"1118","DOI":"10.1056\/NEJM199510263331706","article-title":"Drug-induced hepatotoxicity","volume":"2013","author":"Lee","year":"1995","journal-title":"N Engl J Med"},{"key":"2025082723083065000_2013.apr05_1.bcr2013008591.6","first-page":"1052","article-title":"Drug-induced hepatotoxicity. 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