Laboratory analyses, including direct and indirect Coombs tests, antinuclear antibodies, liver-kidney microsomal antibody, mitochondrial antibody, smooth muscle antibody
, anti-soluble liver antigen, anti-cardiolipin IgM-IgG, anti-phospholipid IgM-IgG, protein electrophoresis, serum and 24-hour-urine copper, serum ceruloplasmin, and fecal alpha-1 antitrypsin did not reveal any abnormalities.
Her serology for autoimmune hepatitis which included antinuclear antibody (ANA), soluble liver antigen, antismooth muscle antibody
, and liver kidney microsomal-1 antibodies was all negative.
Blood work including ANA, anti-dsDNA, ANNAT1, ANNAT2, and ANNAT3, PCCAB 1, 2, and 3, anti-Sm, anti-RNP, anti-SSA, anti-SSB, anti-Scl70, anti-Jo1, ANCA, amphiphysin, striated muscle antibody
, and CRMP-5 was normal.
The patient tested negative for Epstein-Barr virus, cytomegalovirus, herpes simplex virus, human immunodeficiency virus, antinuclear antibody, anti-smooth muscle antibody
, and antimitochondrial antibody.
Sharma, "Acute rhabdomyolysis with severe polymyositis following ipilimumab-nivolumab treatment in a cancer patient with elevated anti-striated muscle antibody
," Journal for Immunotherapy of Cancer, vol.
Other pertinent laboratory examinations performed in consideration of the differential diagnoses for abnormal liver biochemistries were negative, including anti-hepatitis A virus antibody IgM, hepatitis B surface antigen, anti-hepatitis C virus antibody, anti-nuclear antibody, anti-smooth muscle antibody
, anti-mitochondrial antibody, and anti-liver-kidney microsomal antibody.
The anti-nuclear antibody was weakly positive at a titer of 1:40, while the anti-smooth muscle antibody
, anti-mitochondrial antibody and anti-liver kidney microsomal antibody were all negative.
The following tests were performed in all study participants for the study purposes: anti-nuclear antibody (ANA) anti-double stranded DNA (anti- dsDNA) anti-liver/kidney microsomal type 1 (LKM-1) anti-smooth muscle antibody
(Anti-SMA) antimitochondrial antibodies (AMA) perinuclear antineutrophil cytoplasmic antibody (p-ANCA) cytoplasmic ANCA (c-ANCA) anti-SSA/Ro anti- SSB/La anti-Scl-70 anti-centromere antibody Anti-Jo-1 anti-thyroid peroxidase (anti-tpo) Anti thyroglobulin (anti-Tg) Anti-U1small nuclear (sn) RNP (Anti-U1snRNP) Anti Smith antibody (Anti- Sm) and anti-cardiolipin antibodies (ACA).
Table 1: liver screen and autoimmune profile Test Result Hepatitis C antibody Negative Hepatitis B surface antigen Negative Ferritin 85 ug/L (15-300) Caeruloplasmin 0.33g/L (0.19-0.71) Double-stranded DNA antibody 4.44 IU/ml (<10) Nuclear antibody 1 in 1280 IgG Mitochondrial antibody Negative Smooth muscle antibody
Negative Reticulin antibody Negative ENA- Ro/La/RNP/Sm/Jo-1/Scl-70 Negative Liver kidney microsomal antibody Negative Soluble liver antigen antibody Borderline Liver cytosol antibody Negative
A more specific screening tool is the anti-smooth muscle antibody
level; a serum protein electrophoresis also can test for this disease.
Antibodies to a cytosolic soluble liver antigen (SLA), originally detected by an inhibition ELISA using cytosolic liver fractions and proposed as marker of a third type of autoimmune hepatitis (AIH) negative for other autoantibodies, have been also reported in anti-nuclear and/or -smooth muscle antibody
type 1 AIH, liver kidney microsomaltype 2 AIH, and autoimmune sclerosing cholangitis (1-3).
The findings of increased immunoglobulin levels, positive anti-nuclear antibody and positive anti-smooth muscle antibody
in a chronic hepatitis patient indicate: