Cryptogenic Hepatitis

What is Cryptogenic Hepatitis?

It is a chronic inflammatory disease of the liver that can lead to liver cirrhosis and liver cancer.

Causes of this disease

In most cases the cause is not known. However, about 30% of these patients may be caused by occult infection with hepatitis B or hepatitis C viruses, or mild idiopathic ductopenia in adults.

Other possible causes of Cryptogenic Hepatitis

Infected infection by hepatitis B virus (HBV): occult infection with B virus (IOB) is a clinical entity characterized by the detection of VBH DNA in serum and / or liver in the absence of surface antigen of HBV (AgHBs). The VBH genome replicates as in the case of chronic hepatitis B but at a lower intensity, probably due to the control of the patient’s defensive system. Occult infection with B virus (IOB) has been described in patients who have apparently resolved an acute or chronic hepatitis B and even in patients without any other serologic marker of past infection with HBV. The IOB can be transmitted by blood transfusion and cause a classic hepatitis B in the infected person. Also, the IOB may end up in cirrhosis and liver cancer and require liver transplantation. In patients with chronic hepatitis C, IOB induces greater severity and worse prognosis of liver damage. It can be associated with chronic hepatitis C, and infection with human immunodeficiency virus, which can worsen the prognosis in some cases. Cases of reactivation of IOB have been described in patients with antitumor chemotherapy, and although the risk is low, it can cause hepatitis with severe liver damage.
Infection hidden by hepatitis C virus (see section Occult Infection by Virus C).

Mild idiopathic ductopenia of the adult: is a hepatobiliary disease that presents as a mild form of severe idiopathic ductopenia and is characterized by a decrease in a percentage of intrahepatic bile ducts (more than 50%).

In most cases the cause of Cryptogenic Hepatitis is not known.
Dr. Vicente Carreño

Diagnosis

It can only be diagnosed by analysis of liver enzymes (transaminases) and sophisticated molecular biology techniques for hepatitis C virus B or blood or by liver biopsy. The rest of the causes of liver disease must be ruled out.

Adult idiopathic mild ductopenia can only be diagnosed by histopathological analysis of the liver biopsy.

Treatment for Cryptogenic Hepatitis

Depending on the cause, there are several treatments for cryptogenic hepatitis:

Treatment of hidden infection by hepatitis B virus. The therapeutic approach in patients with IOB should be the same as with classic chronic hepatitis B (see section Treatment Chronic Hepatitis B).
Treatment of occult infection by hepatitis C virus (see section on Occult Infection by Virus C).
Mild idiopathic adult Ductopenia: ursodeoxycholic acid, etc.

About 30% of these patients may be caused by occult infection with hepatitis B or C viruses.

How aggressiveness can be predicted

The degree of inflammation and the liver fibrosis stage can be determined by performing a liver biopsy. Liver ultrasound is also used.

References

Rodríguez-Iñigo E, et al. Distribution of hepatitis B virus in the liver of chronic hepatitis C patients with occult hepatitis B virus infection. J Med Virol 2003;70:571-80.
Castillo I, et al. Comparative study on the clinical and virological characteristics among patients with single occult hepatitis B virus (HBV), single occult hepatitis C virus (HCV) and occult HBV and HCV dual infection. J Med Virol 2007;79:236-41.
Carreño V, et al. Occult hepatitis B virus and hepatitis C virus infections. Rev Med Virol 2008;18:139-57.
Urbani S, et al. The role of anti-core antibody response in the detection of occult hepatitis B virus infection. Clin Chem Lab Med 2010;48:23-29.
Raimondo G, et al. Occult HBV infection. Semin Immunopathol 2013;35:39-52.