Skip to main content
PMC home page
Gut logoLink to Gut
. 1970 Oct;11(10):811–816. doi: 10.1136/gut.11.10.811

An interplay of genetic and environmental factors in familial hepatitis and myasthenia gravis

Senga Whittingham, Ian R Mackay, Z S Kiss
PMCID: PMC1553155  PMID: 5485830

Abstract

A family is described in which there occurred two cases of the lupoid type of active chronic hepatitis with cirrhosis, one of chronic persistent hepatitis, and one of myasthenia gravis. The two cases of lupoid hepatitis were in the proposita, a schoolgirl aged 16 years, and her great-aunt aged 69 years whom she had never met. The case of myasthenia gravis was that of the father. The whole family, except the great-aunt, had been exposed to an epidemic of infectious hepatitis five years previously, and the girl and her brother had contracted this disease. The schoolgirl later developed active chronic hepatitis while her brother had chronic persistent hepatitis without immunological concomitants.

Apart from coincidence, some combination of three processes was required to account for the illnesses in this family: a genetic predisposition to chronic liver disease in particular, a genetic predisposition to autoimmune reactions in general, and a `triggering' effect of infection with the hepatitis virus.

Full text

PDF
811

Images in this article

812Fig. 2
on p.812
813Fig. 3
on p.813
813Fig. 4
on p.813
814Fig. 5
on p.814

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. ALARCON SEGOVIA D., GALBRAITH R. F., MALDONADO J. E., HOWARD F. M., Jr SYSTEMIC LUPUS ERYTHEMATOSUS FOLLOWING THYMECTOMY FOR MYSTHENIA GRAVIS. REPORT OF TWO CASES. Lancet. 1963 Sep 28;2(7309):662–665. doi: 10.1016/s0140-6736(63)90456-2. [DOI] [PubMed] [Google Scholar]
  2. CAVELL B., LEONHARDT T. HEREDITARY HYPERGAMMAGLOBULINEMIA AND LUPOID HEPATITIS. Acta Med Scand. 1965 Jun;177:751–759. doi: 10.1111/j.0954-6820.1965.tb01885.x. [DOI] [PubMed] [Google Scholar]
  3. CORRIDAN M. THE THYMUS IN HEPATIC CIRRHOSIS. J Clin Pathol. 1963 Sep;16:445–447. doi: 10.1136/jcp.16.5.445. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. CULLINAN E. R., KING R. C., RIVERS J. S. The prognosis of infective hepatitis; a preliminary account of a long-term follow-up. Br Med J. 1958 Jun 7;1(5083):1315–1317. doi: 10.1136/bmj.1.5083.1315. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Elling P., Ranlov P., Bildsoe P. A genetic approach to the pathogenesis of hepatic cirrhosis. A clinical and serological study. Acta Med Scand. 1966 May;179(5):527–533. doi: 10.1111/j.0954-6820.1966.tb07969.x. [DOI] [PubMed] [Google Scholar]
  6. Franken F. H., Amelung D., Garke P., Pohle D., Liebermeister H., Deupmann F. J. Post-hepatitic cirrhosis of the liver; a follow-up study. Ger Med Mon. 1967 Jul;12(7):305–311. [PubMed] [Google Scholar]
  7. Fudenberg H. H. Immunologic deficiency, autoimmune disease, and lymphoma: observations, implications, and speculations. Arthritis Rheum. 1966 Jun;9(3):464–472. doi: 10.1002/art.1780090310. [DOI] [PubMed] [Google Scholar]
  8. GALBRAITH R. F., SUMMERSKILL W. H., MURRAY J. SYSTEMIC LUPUS ERYTHEMATOSUS, CIRRHOSIS AND ULCERATIVE COLITIS AFTER THYMECTOMY FOR MYASTHENIA GRAVIS. N Engl J Med. 1964 Jan 30;270:229–231. doi: 10.1056/NEJM196401302700504. [DOI] [PubMed] [Google Scholar]
  9. GALLAGHER N. D., GOULSTON S. J. Persistent acute viral hepatitis. Br Med J. 1962 Mar 31;1(5282):906–908. doi: 10.1136/bmj.1.5282.906. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. HOLBOROW J., JOHNSON G. D. ANTINUCLEAR FACTOR IN SYSTEMIC LUPUS ERYTHEMATOSUS. A CONSIDERATION OF THE IMMUNOFLUORESCENT METHOD OF DETECTING ANTINUCLEAR ANTIBODIES, WITH RESULTS OBTAINED IN A FAMILY STUDY. Arthritis Rheum. 1964 Apr;7:119–127. doi: 10.1002/art.1780070204. [DOI] [PubMed] [Google Scholar]
  11. KLATSKIN G. Subacute hepatic necrosis and postnecrotic cirrhosis due to anicteric infections with the hepatitis virus. Am J Med. 1958 Sep;25(3):333–358. doi: 10.1016/0002-9343(58)90072-x. [DOI] [PubMed] [Google Scholar]
  12. KUNKEL H. G., TAN E. M. AUTOANTIBODIES AND DISEASE. Adv Immunol. 1964;27:351–395. doi: 10.1016/s0065-2776(08)60711-7. [DOI] [PubMed] [Google Scholar]
  13. LAWRENCE J. S., BALL J. Genetic studies on rheumatoid arthritis. Ann Rheum Dis. 1958 Jun;17(2):160–168. doi: 10.1136/ard.17.2.160. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. LEONHARDT T. FAMILY STUDIES IN SYSTEMIC LUPUS ERYTHEMATOSUS. Acta Med Scand. 1964;176:SUPPL 416–416:1+. [PubMed] [Google Scholar]
  15. Linke A. Thymustumor mit lupoider Hepatitis. Schweiz Med Wochenschr. 1965 Oct 30;95(44):1492–1494. [PubMed] [Google Scholar]
  16. MADDREY W. C., IBER F. L. FAMILIAL CIRRHOSIS: A CLINICAL AND PATHOLOGICAL STUDY. Ann Intern Med. 1964 Oct;61:667–679. doi: 10.7326/0003-4819-61-4-667. [DOI] [PubMed] [Google Scholar]
  17. Mackay I. R., Whittingham S. "Auto-immune" chronic hepatitis. Postgrad Med. 1967 Jan;41(1):72–83. doi: 10.1080/00325481.1967.11696105. [DOI] [PubMed] [Google Scholar]
  18. Mathews J. D., Mackay I. R. Australia antigen in chronic hepatitis in Australia. Br Med J. 1970 Jan 31;1(5691):259–261. doi: 10.1136/bmj.1.5691.259. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. NEEFE J. R., GAMBESCIA J. M., KURTZ C. H., SMITH H. D., BEEBE G. W., JABLON S., REINHOLD J. G., WILLIAMS S. C. Prevalence and nature of hepatic disturbance following acute viral hepatitis with jaundice. Ann Intern Med. 1955 Jul;43(1):1–32. doi: 10.7326/0003-4819-43-1-1. [DOI] [PubMed] [Google Scholar]
  20. NEFZGER M. D., CHALMERS T. C. THE TREATMENT OF ACUTE INFECTIOUS HEPATITIS. TEN-YEAR FOLLOW-UP STUDY OF THE EFFECTS OF DIET AND REST. Am J Med. 1963 Sep;35:299–309. doi: 10.1016/0002-9343(63)90173-6. [DOI] [PubMed] [Google Scholar]
  21. POLLAK V. E. ANTINUCLEAR ANTIBODIES IN FAMILIES OF PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS. N Engl J Med. 1964 Jul 23;271:165–171. doi: 10.1056/NEJM196407232710401. [DOI] [PubMed] [Google Scholar]
  22. VAN LOGHEMJ VIRAL INFECTION AND IDIOPATHIC AUTOIMMUNE DISEASES: A HYPOTHESIS. Vox Sang. 1965 Jan-Feb;10:1–5. [PubMed] [Google Scholar]
  23. VELDEK T. E., ABELS J., ANDERS G. J., ARENDS A., HOEDEMAEKER P. J., NIEWEG H. O. A FAMILY STUDY OF PERNICIOUS ANEMIA BY AN IMMUNOLOGIC METHOD. J Lab Clin Med. 1964 Aug;64:177–187. [PubMed] [Google Scholar]
  24. Wangel A. G., Callender S. T., Spray G. H., Wright R. A family study of pernicious anaemia. II. Intrinsic factor secretion, vitamin B12 absorption and genetic aspects of gastric autoimmunity. Br J Haematol. 1968 Feb;14(2):183–204. doi: 10.1111/j.1365-2141.1968.tb01486.x. [DOI] [PubMed] [Google Scholar]
  25. Whittingam S., Mackay I. R. Laboratory methods for diagnosis of autoimmune disease. Med J Aust. 1969 Jun 7;1(23):1200–1205. doi: 10.5694/j.1326-5377.1969.tb62269.x. [DOI] [PubMed] [Google Scholar]
  26. Whittingham S., Ungar B., Mackay I. R., Mathews J. D. The genetic factor in pernicious anaemia. A family study in patients with gastritis. Lancet. 1969 May 10;1(7602):951–954. doi: 10.1016/s0140-6736(69)91856-x. [DOI] [PubMed] [Google Scholar]
  27. Williams R. C., Jr, Kenyon A. J., Huntley C. C. Immunoglobulins, viruses, and speculation on their interrelationship in certain human and animal disease states. Blood. 1968 Apr;31(4):522–535. [PubMed] [Google Scholar]
  28. ZIEVE L., HILL E., NESBITT S., ZIEVE B. The incidence of residuals of viral hepatitis. Gastroenterology. 1953 Dec;25(4):495–531. [PubMed] [Google Scholar]
  29. ZIFF M., SCHMID F. R., LEWIS A. J., TANNER M. Familial occurrence of the rheumatoid factor. Arthritis Rheum. 1958 Oct;1(5):392–399. doi: 10.1002/art.1780010503. [DOI] [PubMed] [Google Scholar]

Articles from Gut are provided here courtesy of BMJ Publishing Group

RESOURCES