Trombosis del seno venoso posterior asociada a posible hepatitis autoinmune. Reporte de caso

Introduction: Cerebral venous sinus thrombosis (CVST) accounts for approximately 0.5–1% of all strokes, mainly affecting young and middle-aged patients, and is associated with prothrombotic conditions, including autoimmune diseases. Autoimmune hepatitis (AIH), although primarily a hepatic disorder, may present with extrahepatic manifestations and generate a prothrombotic state through chronic inflammation, pro- and anticoagulant imbalance, and endothelial dysfunction. We describe a case in which CVST is associated with suspected early-stage AIH. Case report: A 57-year-old woman with no relevant past medical history presented with intermittent headache for one year, which worsened during the three weeks prior to admission and was accompanied by vomiting and self-medication with high-dose paracetamol. Brain MRI and venous CT angiography revealed thrombosis of the superior sagittal sinus and the left transverse sinus, and anticoagulation with low-molecular-weight heparin was initiated. During hospitalization, she developed marked cytolysis (AST 116 U/L, ALT 195 U/L, GGT 1065 U/L), initially attributed to paracetamol-induced hepatotoxicity, for which N-acetylcysteine was administered. Clinical course: Hepatic abnormalities persisted, and antinuclear antibodies (ANA) were detected at a titer of 1:320 (centromere pattern), along with elevated IgG levels, with no evidence of primary thrombophilia. On follow-up, liver function tests partially improved, although GGT and IgG levels remained elevated. Follow-up ultrasound showed a micronodular hepatic pattern consistent with chronic liver disease, which, together with positive serology, suggested previously undiagnosed autoimmune hepatitis or AIH triggered after the initial liver injury. The patient was transitioned to oral anticoagulation with rivaroxaban. Conclusion: This case highlights a possible association between CVST and early autoimmune hepatitis, in which the inflammatory state and immune dysregulation may have contributed to the thrombotic event. In patients with CVST without clear risk factors, early immunological and hepatological evaluation should be considered to identify underlying systemic causes and guide timely management that may modify neurological and hepatic outcomes.