Endocrine Abstracts

Introduction: Primary biliary cirrhosis and autoimmune hepatitis are two chronic liver diseases. An overlap of the characteristic signs of these two conditions, determining an ‘Overlap syndrome’ can be seen. Type 1 diabetes can be associated with this syndrome due to the autoimmune predisposition.

Observation: We report the case of a young type 1 diabetic patient referred to our service for additional management of a glycemic imbalance. This is a 15 year old female patient with type 1 diabetes since the age of 4. The clinical examination showed a diffuse sensitivity of the supra-umbilical stage with a maximum in the right hypochondrium and hepatomegaly. In biology, hepatic cytolysis was found to be 17 times normal and anicteric cholestasis with high γGT (3 times normal) with correct TP. As part of the exploration of this hepatopathy, hepatitis B and C serologies and an autoimmunity assessment were requested. The anti mitochondria and anti smooth muscle antibodies were negative, on the other hand the gp 210 and SLA/LP antibodies were positive. The liver biopsy puncture objectified a chronic liver disease with septal fibrosis classified A2F2 according to Metavir framing with a primary biliary cirrhosis associated with lesions of autoimmune hepatitis (interface hepatitis) evoking an Overlap syndrome. The patient was put on ursodeoxycholic acid, corticosteroid therapy and immunosuppressant. The evolution was marked by the rapid normalization of cholestasis and cytolysis.

Conclusion: Our observation illustrates the importance of early diagnosis of autoimmune diseases that may be associated with type 1 diabetes in order to allow rapid and adequate medical care.