Tantangan Diagnosis dan Tata Laksana Kecurigaan Hepatitis Autoimun pada Wanita 34 tahun dengan Periodik Paralisis dan Penyakit Graves

Yeni Larasati, C. Singgih Wahono

Abstract

Hipokalemia periodik paralisis merupakan suatu kelemahan otot yang dapat disebabkan oleh kondisi hipertiroid akibat penyakit Graves. Prevalensi penderita hipokalemia periodik paralisis dengan gejala tirotoksikosis mencapai 10%. Penyakit Graves merupakan suatu kelainan sistem imun yang dapat menyebabkan disfungsi organ lainnya seperti pada kondisi hepatitis autoimun. Penegakan diagnosis hepatitis auotimun saat ini masih menjadi tantangan bagi klinisi karena ada keterbatasan fasilitas pelayanan pemeriksaan penunjang seperti smooth muscle antibodies (SMA), antimitochondrial antibodies (AMA), anti-liver/kidney microsomal antibodies type 1 (anti LKM-1), yang seringkali masih sulit didapatkan. Artikel ini membahas mengenai kasus wanita 34 tahun dengan kelemahan anggota gerak tubuh sejak 3 bulan dan memberat, penurunan berat badan sebanyak 4 kg dalam waktu 1 bulan, sering merasa lapar, gelisah dan sulit tidur karena tidak tahan terhadap udara panas dan berdebar-debar. Pada pasien didapatkan urin berwana keruh sejak 10 hari terakhir. Hasil pemeriksaan laboratorium menunjukkan peningkatan kadar alanin transminase (ALT) 256 U/I dan aspartat aminotransferase (AST) 142 U/I disertai peningkatan kadar bilirubin total 12,09 mg/dl, bilirubin direct 10,5 mg/dl. Penanda infeksi virus hepatitis HbsAg non-reaktif dan anti-HCV negatif, kadar kalium 2,29 mmol/L, dan antinuclear antibody test 1,3 IU/ml, thyroid stimulating hormone (TSH) <0,01 uIU/ml, dan FT4 5,46 mg/dl. Hasil USG abdomen menunjukkan chronic liver disease. Histopatologi dari jaringan liver menunjukkan kronik hepatitis dengan infiltrasi inflamatori. Pasien diterapi dengan pemberian tiamazol, suplemen potasium, propranolol, dan prednison. Hasilnya, keluhan dan fungsi hati membaik.
Kata Kunci: Hepatitis autoimun, penyakit Graves, periodik paralisis, tata laksana

The Challenges of Diagnosis and Management of Suspected Autoimmune Hepatitis in a 34-Year-Old Woman with Periodic Paralysis and Graves’ Disease

Periodic paralysis hypokalemia is a muscle weakness that can be caused by hyperthyroidism due to Graves’ disease. The prevalence reaches 10% of patients with periodic paralysis hypokalemia with symptoms of thyrotoxicosis. Graves’ disease is an immune system disorder that can cause other organ dysfunction, such as autoimmune hepatitis. Currently, the diagnosis of autoimmune hepatitis is still a challenge for clinicians due to limited supporting examination facilities, such as SMA, AMA, anti-LKM-1. This article discusses a case of a 34-year-old woman with limb weakness for 3 months, losing 4 kg of weight in 1 month, often feeling hungry, restless, having trouble sleeping, unable to stand the heat, and palpitation. Her urine was looked like a tea color for the last 10 days. Laboratory examination results showed an increase in alanine transaminase (ALT) levels 256 U/I and aspartate aminotransferase (AST) 142 U/I, accompanied by an increase in total bilirubin levels of 12.09 mg/dl, direct bilirubin 10.5 mg/ dl. Markers of hepatitis B (HbsAg) and anti-HCV were negative. The potassium level was 2.29 mmol/L and the antinuclear antibody test was 1.3 IU/ml. Thyroid-stimulating hormone (TSH) <0.01 uIU/ml, and FT4 5.46 mg/dl. Abdominal ultrasound showed chronic liver disease. Histopathology of liver tissue showed chronic hepatitis with inflammatory infiltration. The patient had been treated with thiamazole, potassium supplements, propranolol, and prednisone. As a result, the patient’s condition and liver enzyme tests improved.

Keywords

Autoimmune hepatitis, Grave’s disease, management, periodic paralysis

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