Case report: liver failure as a debut of autoimmune hepatitis triggered by dengue virus in a pregnant woman




Hepatitis, autoimmune, Dengue Virus, Pregnant, Liver Failure, Acute, Infections


Autoimmune hepatitis (AIH) is a complex condition with unclear origins, involving genetic susceptibility and environmental triggers that lead to immune system dysfunction. We report a case of a pregnant woman from a mosquito-borne disease-endemic area who presented jaundice, abdominal pain, and pruritus, complicated by acute liver failure. Immunological markers showed AIH triggered by dengue virus infection, which was confirmed by a positive IgM test. Treatment with supportive care followed by steroids and azathioprine resulted in favorable outcomes, averting the need for a liver transplant. Although AIH can be triggered by viruses, the role of dengue in its pathogenesis remains poorly understood. Regular clinical monitoring is vital for managing AIH, particularly  during pregnancy, due to variable immune status and treatment responses. Further research is necessary to understand the link  between dengue infection and AIH. Individualized treatment strategies are crucial, especially during pregnancy, in order to ensure favorable outcomes.


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Cabezas C, Fiestas V, García-Mendoza M, Palomino M, Mamani E, Donaires F. Dengue en el Perú: a un cuarto de siglo de su reemergencia. Rev Peru Med Exp Salud Publica. 2015;32(1):146-56.

Luque N, Cilloniz C, Pons MJ, Donaires F, Albornoz R, Mendocilla-Risco M, et al. Características clínicas y epidemiológicas de las muertes por dengue durante un brote en el norte del Perú. Rev Peru Med Exp Salud Publica. 2023;40(1):67-72. doi: 10.17843/rpmesp.2023.401.12148.

Gutierrez EL, Piazza M, Gutierrez-Aguado A, Hijar G, Carmona G, Caballero P, et al. Uso de la evidencia en políticas y programas de salud aportes del Instituto Nacional de Salud. Rev Peru Med Exp Salud Publica. 2016;33(3):580-584. doi: 10.17843/rpmesp.2016.333.2308.

World Health Organization. Disease Outbreak News; Dengue – Global situation. [citado 4 de abril de 2024]. Disponible en:

Dengue guidelines, for diagnosis, treatment, prevention and control. World Health Organization: 2009. [citado 4 de abril de 2024]. Disponible en:

Juneja D, Jain R, Nasa P. Dengue induced acute liver failure: A meta summary of case reports. World J Virol 2024; 13(1): 91457. doi: 10.5501/wjv.v13.i1.91457.

Jagtap AB, Chirant S, Chaitanya V, Lall B, Porwal YC. Autoimmune hepatitis unmasked by dengue infection - An unexplored and rare association. Trop Doct. 2023;53(1):181-182. doi: 10.1177/00494755221130127.

Vento S, Guella L, Mirandola F, Cainelli F, Di Perri G, Solbiati M, et al. Epstein-Barr virus as a trigger for autoimmune hepatitis in susceptible individuals. Lancet. 1995;346(8975):608-609. doi: 10.1016/s0140-6736(95)91438-2.

Hong JK, Chopra S, Kahn JA, Kim B, Khemichian S. Autoimmune hepatitis triggered by COVID-19. Intern Med J. 2021;51(7):1182-1183.

doi: 10.1111/imj.15420.

Olivas I, Rodríguez-Tajes S, Londoño MC. Autoimmune hepatitis: Challenges and novelties. Hepatitis autoinmune: retos y novedades. Med Clin (Barc). 2022;159(6):289-298. doi: 10.1016/j.medcli.2022.04.004.

McPhail MJ, Farne H, Senvar N, Wendon JA, Bernal W. Ability of King’s College Criteria and Model for End-Stage Liver Disease Scores to Predict Mortality of Patients With Acute Liver Failure: A Meta-analysis. Clin Gastroenterol Hepatol. 2016;14(4):516-e45. doi: 10.1016/j.cgh.2015.10.007.

European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Autoimmune hepatitis. J Hepatol. 2015;63(4):971-1004. doi: 10.1016/j.jhep.2015.06.030.

Sirbe C, Simu G, Szabo I, Grama A, Pop TL. Pathogenesis of Autoimmune Hepatitis-Cellular and Molecular Mechanisms. Int J Mol Sci.

;22(24):13578. doi: 10.3390/ijms222413578.

Bhatt P, Sabeena SP, Varma M, Arunkumar G. Current Understanding of the Pathogenesis of Dengue Virus Infection. Curr Microbiol.

;78(1):17-32. doi: 10.1007/s00284-020-02284-w.

Kamolratanakul S, Thungthong P, Nakhakes C, Kittiyanpanya C, Chonsawat P, Chamnanchanunt S. False-positive dengue IgM test result in a patient with systemic lupus erythematosus: a case report. Asian Biomed. 2020;14(5):209-213. doi: 10.1515/abm-2020-0030.

Takasaki T, Nawa M, Yamada KI, Harada M, Takeda A, Kurane I. Evaluation of dengue IgM detection tests using sera from patients

with autoimmune diseases. J Virol Methods. 2002;102(1-2):61-66. doi: 10.1016/s0166-0934(01)00449-9.

Mack CL, Adams D, Assis DN, Kerkar N, Manns MP, Mayo MJ, et al. Diagnosis and Management of Autoimmune Hepatitis in Adults

and Children: 2019 Practice Guidance and Guidelines From the American Association for the Study of Liver Diseases. Hepatology. 2020;72(2):671-722. doi: 10.1002/hep.31065.

Braga A, Vasconcelos C, Braga J. Autoimmune hepatitis and pregnancy. Best Pract Res Clin Obstet Gynaecol. 2020;68:23-31. doi:


Wang CW, Grab J, Tana MM, Irani RA, Sarkar M. Outcomes of pregnancy in autoimmune hepatitis: A population-based study. Hepatology. 2022;75(1):5-12. doi: 10.1002/hep.32132.





Case Report

How to Cite

Sato-Espinoza K, Berrospi D, Diaz-Ferrer J. Case report: liver failure as a debut of autoimmune hepatitis triggered by dengue virus in a pregnant woman. Rev Peru Med Exp Salud Publica [Internet]. 2024 Jun. 21 [cited 2024 Jul. 25];41(2):209-13. Available from:

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