Chronic active hepatitis at Baragwanath Hospital

In a retrospective analysis of 35 Black patients with chronic active hepatitis (CAH) admitted to Baragwanath Hospital, Johannesburg, during the period 1972-1980, four major aetiological categories were found: auto-immune (lupoid, immunological (57%», drug-induced (isoniazid and a-methyldopa (17%», heptatitis B virus-related (14%), and alcohol-related (11%) CAH. Alcohol-related CAH was found in males only. Upper abdominal pafn was a presenting feature of alcohol-induced CAH, while jaundice was a common. presenting feature of the other types. Systemic features such as skin rashes (acne, urticaria), bacterial infections and congestive cardiac failure were prominent in the auto-immune type of CAH. The liver was enlarged in the majority of cases. Hepatitis B virus-related CAH showed an absence of tissue nonspecific auto-antibodies. Cirrhosis was present in approximately 50% of patients at the time of diagnosis. Despite the facts that isoniazid and a-methyldopa are commonly used and hepatitis B infections and alcohol abuse are 'frequent in this population, CAH. remains an uncommon condition in South African Blacks.