Q. Is it fine to take Prednisone and Azathioprine for autoimmune hepatitis?

Answered by
Dr. Sadaf Mustafa
and medically reviewed by iCliniq medical review team.

Hi doctor,

I have been itching throughout my body, especially after eating, for about two years. I noticed fatigue and shortness of breath about 18 months ago. I stopped smoking before seven years. I stopped drinking before a year as my upper abdominal area started paining after drinking. Before five months, I had undergone treatment. But, my liver had enlarged and I had antimitochondrial antibody. So, my doctor prescribed Ursodiol and referred me to a gastroenterologist. The gastroenterologist ordered a biopsy and he said that it is unremarkable. He suggested me to stop taking Ursodiol and come back for another biopsy in six months. I did not go again to the doctor, because I have severe health issues. My other health issues are as follows: Less muscle strength and stamina during exercise, light-colored stools, gained 30 lbs in the last year with the same diet, trouble in sleeping, reading, concentrating, memory, changes in body temperature, fever, higher pulse of 80-90, acne on back, frequent urination, cellulite on butt and legs. I took Creon or Pancreatin and it reduces tingling or itching in legs. I got AMA, ASMA, ANA, blood panel and liver panel done. I lead to believe that my issues could be an irregular form of autoimmune hepatitis and was prescribed Prednisone and Azathioprine. Please suggest me what should I do now. Also, a primary care physician is willing to give me corticosteroid treatment with this. Please help.

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Dr. Sadaf Mustafa

MBBS., RESEARCH FELLOWSHIP., MD (INTERNAL MEDICINE) RESIDENCY COMPLETION., DIPLOMATE IN AMERICAN BOARD OF
General Medicine Internal Medicine

Hi,

Welcome to icliniq.com. There are a few important facts I would want you to consider.

  • We have to rule out other forms of hepatitis like viral hepatitis, amyloid or iron deposition, NASH (nonalcoholic steatohepatitis) and alcoholic liver disease.
  • All three markers are non-specific; anti-LMK (anti-liver kidney microsomal antibody) may add to the diagnosis and also have to take a typical picture on the imaging for the PBC (primary biliary cholangitis).
  • I am not sure what were the results of your ultrasound or CT of the abdomen. I would like to see the result, please send the copy.
  • For AIH (autoimmune hepatitis) your antibodies should be more markedly positive, it appears a little unlikely. You may have false positive AMA and anti-SMA.
  • Azathioprine is a toxic medication and should not be taken if you are not absolutely certain about the diagnosis. It is usually given by a specialist but a primary care physician can prescribe as well.
  • If Prednisone is the treatment of choice you would have to take it for life. Again, it is not a fun medication to take unless indicated.
  • My suggestion would be to get a second opinion with another gastroenterologist in person.

For further information consult an internal medicine physician online --> https://www.icliniq.com/search/online-doctors-directory/internal-medicine-physician

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