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

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.